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SAN'JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> Account ID AR0003549 <br /> INVOICE <br /> <br /> Date Printed 10/31/2019 <br /> VECKER, GARY RE : ORCHARD SUPPLY HARDWARE#1570 <br /> CASSIE BRAVO 2650 MACARTHUR DR STE A <br /> 6450 VIA DEL ORO TRACY, CA 95376 <br /> SAN JOSE, CA 95119 <br /> OWNER : ORCHARD SUPPLY COMPANY, LLC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0326472---Date of Invoice: 9/26/2019 11111 11111 11111 11111 HE 11111 11111 11111 1111 111111 11111 1111 IN <br /> 9/26/2019 1921 HMBP-Regular-Primary Location $ 789.00 <br /> 9/26/2019 1922 CERS Processing Fee $ 30.00 <br /> 9/26/2019 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> 9/26/2019 2832 AST FAC 10 K-</=100 K GAL CUMULATIVE $ 743.00 <br /> 9/26/2019 APSA APSA SURCHARGE $ 26.00 <br /> Total for this Invoice $ 1,637.00 <br /> Payment Due Date 10/27/2019 <br /> TOTAL DUE this Billing Period $ 1,637.00 <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For HMBP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />