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.JHMJUAWUIIV L UUIV I T <br /> Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMF"'T <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 9 <br /> <br /> <br /> Facility ID FA0003290 <br /> Date Printed 2/6/2006 <br /> TARANJIT &TEJINDER SANDHU RE : COUNTRY MART DIESEL & GAS <br /> COUNTRY MART DIESEL & GAS 34243 S CHRISMAN RD <br /> 34243 S CHRISMAN RD TRACY, CA 95304-9334 <br /> TRACY, CA 95304-9334 <br /> OWNER : SANDHU, TARANJIT S & TEJINDER <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143375---Date of Invoice: 1/27/2006 11111 1111 111111 11111 IN IIII <br /> 1/27/2006 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 115.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2362 UST FACILITY&1 TANK $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,274.00 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period 1,274.0 <br /> SAN JOAOUIN Cl . <br /> ENVIRON pRcN1 <br /> F{ ALTH DEP.. <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 />