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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPA TMF T , <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0003117 <br /> Facility ID FA0003539 <br /> Date Printed 1/30/2006 <br /> BIRLA, SANJAY RE : S B GAS & MARKET <br /> S B GAS & MARKT 515 W 11TH ST STE 301 <br /> PO BOX 55277 TRACY, CA 95376 <br /> HAYWARD, CA 9 45 <br /> OWNER : BIRLA, SANJAY <br /> Date Health <br /> Program Descriptio i Amount <br /> Invoice# IN0143418---Date of Invoice : 1/27/2006 11111 1111 111111 11111 1111 IN <br /> 1/27/2006 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/27/2006 2244 2006 HAZ AT FEE $ 100.00 <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 2362 UST FACILITY& 1 TANK $ 500.00 <br /> 1/27/2006 2399 UNIFIED DROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,119.00 <br /> Payment Due Date 3/1/ <br /> TOTAL DUE this Billing Period $ 1,119.00 <br /> PAYt <br /> RE <br /> SAN JOAQUIN OGUNT� <br /> ENVIR0NMEt4TAL <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 />