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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTP' 1T Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 9 <br /> <br /> AR0017980 <br /> Facility ID FA0010980 <br /> Date Printed 1/24/2005 111 <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# IN0128415---Date of Invoice: 1/24/2005 11111111111111IIIVIII VIII VIII VIII VIII VIII VIII 11111 IN 11111111111 <br /> IIII IIII <br /> 1/24/2005 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 145.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 369.00 <br /> Payment Due Date 2/23/ 05 <br /> TOTAL DUE this Billing Period $ 369.00 <br /> PAYMENT <br /> RECEIVED <br /> JAN 3 1 2005 <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 /> 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 />