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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMr-'r Page 1 <br /> 304 E WEBER AVE -3RD FLOOR' <br /> STOCKTON, CA 95202 <br /> <br /> ID AR0016997 <br /> Facility ID FA0009997 <br /> Date Printed 2/5/2004 <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 : CRAIG FURGISON <br /> Date Health <br /> Program Descriptio Amount <br /> Invoice# IN0115864---Date of Invoice: /4/2004 <br /> 2/4/2004 2220 SM HW G N<5 TONS/YR $ 200.00 <br /> 2/4/2004 2244 2004 HAZI 1AT FEE $ 145.00 <br /> 2/4/2004 2399 UNIFIED F ROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 369.00 <br /> Payment Due Date 3/6/2004 <br /> TOTAL DUE this Billing Period $ 369.00 <br /> ,�EC�.1Vt=tom <br /> FEg 7 <br /> SAN JOAQUIN COUN-N <br /> �E�NI..TN DEFA'�T�ENT <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 /> 5255.rpt <br />