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5AN JUAUUIN WUN I Y <br /> ENVIRONMENTAL HEALTH DEPARTM� 'T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> <br /> AccountlD AR0017980 <br /> Facility ID FA0010980 <br /> Date Printed 1/30/2006 <br /> G&L BROCK CONSTRUCTION CO INC RE : G&L BROCK CONSTRUCTION CO INC <br /> 4145 CALLOWAY CT 4145 CALLOWAY CT <br /> STOCKTON, CA 95215-2400 STOCKTON, CA 95215-2420 <br /> OWNER : GARY& LYNNE BROCK <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143137--Date of Invoice: 1/27/2006 11111 11111 11111 11111 11111 IN 111111 11111 1111 IN <br /> 1/27/2006 2220 SM HW GEN<5 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 $ 369. <br /> PAYMENT <br /> IEB o 9 2006 <br /> SAN JOAQUIN COUN7y <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />