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JAN JUAWUIN I:UUN I T <br /> ENVIRONMENTAL HEALTH DEPARTMr"" r +� ' Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA <br /> <br /> AR0002864 <br /> Facility ID FA0003290 <br /> Date Printed 1/2_6/20 <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# IN0157208---Date of Invoice : 1/25/2007 1111111 111111 P 11111 11111 11111 11111 11111 11111 11111 11111 11111 11111 1111 111111 11111 1111 1111 <br /> 1/25/2007 2220 SM HW GEN<5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE $ 115.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2362 UST FACILITY& 1 TANK $ 500.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,280.00 <br /> Payment Due Date 2/25/ 7 <br /> TOTAL DUE this BillingPeriod $ 1,280.00 <br /> REO VE <br /> FEB 0 5 2007 <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 /> 5254.rpt <br />