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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTA Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 9 <br /> <br /> AR0017980 <br /> Facility ID I FA0010980 <br /> Date Printed2/27/2003 <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 /> nr .� nocrrintinn Amount <br /> Invoice# IN0103937—Date of Invoice: 2/27/2003 <br /> 2/27/2003 2220 SM HVV GEN<5 TONS/YR $ 200.00 <br /> 2/27/2003 2244 2003 HMMP Annual Fee $ 145.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 17.50 <br /> Total for this Invoice $ 362.50 <br /> Payment Due Date 3/29/2003 <br /> TOTAL DUE this Billing Period $ 362.50 <br /> PAYMENT <br /> RECEIVED <br /> AYMEM- <br /> RECEIVED <br /> MAR 3 1 2003 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <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 all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5255.rpt <br />