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SAN JOAQIfIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTI T <br />600 E MAIN STREET <br />STOCKTON, CA 95202 <br />Phone: (209) 468-3420 <br />INVOICE <br /> <br /> <br /> <br /> <br />Page 1 <br />Account ID AR0028251 <br />Facility ID FA0016164 <br />Date Printed 1/30/2012 <br />RE: TRACY POWER EQUIPMENT <br />7575 CARMELO AVE <br />TRACY, CA 95304 <br />OWNER: BOK, WADE A <br />Total for this Invoice $ 262.00 <br />Payment Due Date 2/29/2012 <br />TOTAL DUE this Billing Period $ 262.00 <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 thereafte <br />5254.rpt <br />Health <br />Date <br />Pruyiam <br />Description <br />Amount <br />Invoice # IN0224904 --- Date <br />of Invoice :1/30/2012 <br />11111 1111 <br />111111 11111 1111 IN <br />1/27/2012 <br />2220 <br />SM HW GEN <5 TONSNR <br />$ <br />213.00 <br />1/27/2012 <br />2399 <br />UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />$ <br />24.00 <br />1/27/2012 <br />ERSC <br />ELECTRONIC REPORTING STATE SURCHARGE FEE <br />$ <br />25.00 <br />Total for this Invoice $ 262.00 <br />Payment Due Date 2/29/2012 <br />TOTAL DUE this Billing Period $ 262.00 <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 thereafte <br />5254.rpt <br />