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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMr Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR • <br /> STOCKTON, <br /> <br /> OICE Account ID AR0016992 <br /> Facility ID FA0009992 <br /> Date Printed 1/30/2006 <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# IN0142891 ---Date of Invoice : 1/27/2006 I(IIIIII IIIIII III VIII VIII VIII VIII VIII VIII IIIII IIIII VIII IIII IIIIII VIII IIII IIII <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 360.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoicel $ 584.00 <br /> Payment Due Date f` <br /> TOTAL DUE this Billing Period 584.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 16 2001 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 />