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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTN 'T Page 1 <br /> 304 i=WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 952 <br /> <br /> <br /> Account ID AR0016992 <br /> Facility ID FA0009992 <br /> Date Printed 2/27/2003 <br /> w <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 /> F rcgram nescrintion Amount <br /> Invoice# IN0103659---Date of Invoice: 2/27/2003 <br /> 2/27/2003 2220 SM HW GEN<5 TONS/YR $ 200.00 <br /> 2/27/2003 2244 2003 HMMP Annual Fee $ 360.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> Total for this Invoice $ 577.50 <br /> Payment Due Date 3/29QW3 <br /> TOTAL DUE this Billing Period $ 577.50 <br /> PAYMENT <br /> RECEIVED - = <br /> APR 7 2003 <br /> SAN JOAUJIN(--d1NT`( <br /> PUBLlr,Nt;.liH. <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 all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5255.rpt <br />