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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEP RTV T Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR <br /> <br /> <br /> <br /> <br /> <br /> NC #5446" RE : CIRCLE K STORES INC#5446* <br /> PO BOX 52085 1403 W COUNTRY CLUB BLVD <br /> PHOENIX,AZ 8507 -2085 STOCKTON, CA 95204 <br /> OWNER . T - O-- <br /> Circle K Stores Inc, <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0110256---Date of Invoice : 81/2003 <br /> 8/1/2003 2220 SM HW GE <5 TONS/YR S 200.00 <br /> 8/15/2003 9996 APPLY DISCOUNT <br /> ($ 100.00) <br /> Total for this Invoice $ 100.00 <br /> Payment Due Date 8/31/ <br /> TOTAL DUE this Billing Period 100.00 <br /> PAYMENT <br /> REC1IVED <br /> A!Irl 15 200,; <br /> SAN JOAOUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> f'�Ajo DIVI510N <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 15 Days after the Invoice Date 60 Days of ie Invoice Date and each 30 Days thereafter <br /> 52i5.r(,t <br />