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JAN JUAWUIN t UUN 1 T <br /> ENVIRONMENTAL HEALTH DEPARTMF"'T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR, <br /> STOCKTON, CA 95202 <br /> <br /> Account ID AR0016997 <br /> Facility ID FA0009997 <br /> Date Printed 1/30/2006 <br /> COUNTRY CLUB SERVICE RE : COUNTRY CLUB SERVICE <br /> 1403 W COUNTRY CLUB BLVD 1403 W COUNTRY CLUB BLVD <br /> STOCKTON, CA 95204 STOCKTON, CA 95204 <br /> OWNER : GRIFFEN, STEPHEN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0142893---Date of Invoice: 1/27/2006 11111111 EIII 111 11111 11111 11111 11111 11111 11111 11111 11111 11111 IN 111111 11111 1111 1111 <br /> 1/27/2006 2220 SM HW GEN 15 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 145.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 369.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 69. <br /> PAYMEN1 <br /> REC`�IVEL' <br /> FEB <br /> SAN JOAQUIN COUN:Y <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Please make Checks PA ABLE 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 /> 5254.rpt <br />