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SAN JO!nQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPART` NT <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, C <br /> <br /> AR0016992 <br /> Facility ID FA0009992 <br /> Date Printed 1/24/2005 <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 /> Health <br /> Date Program Description Amount <br /> Invoice# IN0128162--Date of Invoice: 1/24/2005 1111111 11IT 111 11111 11111 11111 11111 11111 X111111111111111111 X111 11111111111111Ips <br /> 1/24/2005 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 360.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 584.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period $ 584.00 <br /> PAYNAE <br /> RECEIVED <br /> FEB 1 8 2005 <br /> SAN JOAOUIN 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 OES/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 /> ;2;5 rpt <br />