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01AN JUMWUIN I.VUIV 1 T <br /> ENVIRONMENTAL HEALTH DEPARTM' Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 9 <br /> <br /> AccountlD AR0016992 <br /> Facility ID FA0009992 il <br /> Date Printed 1/26/2007 <br /> GB INDUSTRIAL SPRAY INC RE : GB INDUSTRIAL SPRAY INC <br /> 1140 BESSEMER AVE#1 1140 BESSEMER AVE 1 <br /> MANTECA, CA 95337-6118 MANTECA, CA 95337 <br /> OWNER : GARY BEAUCHAMP <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0156743---Date of Invoice : 1/25/2007 11111 11111 11111 IN 111111 11111 1111 IN <br /> 1/25/2007 2220 SM HW GEN<5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 360.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 590.00 <br /> Payment Due Date 2/25/2007 <br /> TOTAL DUE this Billing Period $ 590.00, <br /> L7 <br /> r Ed 2 ] 2001 <br /> t:NV/RC,�� "OU/J7y <br /> HEALTH D�p�pTMEhlT <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 DES/HMMP 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 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />