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SAN JOAQUIN COUNTY <br /> Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMF <br /> 600 E MAIN STREET <br /> STOCKTON, CA 9 <br /> <br /> AR0016992 <br /> Facility ID FA0009992 <br /> Date Printed1/28/2008 <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# IN0170382---Date of Invoice: 1/25/2008 I IIIIII IIIIII III VIII VIII VIII IIIII IIIII IIIII VIII VIII Illfl IIII IIIIII VIII IIII IIII <br /> 1/25/2008 2220 SM HW GEN <5 TONS/YR I 213.00 <br /> 1/25/2008 2244 2008 HAZMAT FEE $ 360.00 <br /> 1/25/2008 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 597.00 <br /> Payment Due Date 2/27/2008 <br /> TOTAL DUE this Billing Period $ 597.00 <br /> pAYM`vED <br /> RECE <br /> FEB 2 1 Zoos <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 /> Pen <br /> �Wsfl '/. <br /> to all Permit Fees For OES/HMMP Fees For all SERVICE FEES <br /> a a f the Base Fee Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% <br /> Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />