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SR0084975 (4)
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2900 - Site Mitigation Program
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SR0084975 (4)
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Last modified
10/26/2022 2:08:55 PM
Creation date
10/26/2022 2:04:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
BILLING
RECORD_ID
SR0084975
PE
2903
FACILITY_ID
FA0027045
FACILITY_NAME
1992 NORTH DELTA SEEPAGE MONITORING
STREET_NUMBER
20250
Direction
N
STREET_NAME
STATEN ISLAND
STREET_TYPE
RD
City
THORNTON
Zip
95686
APN
06902019
ENTERED_DATE
3/9/2022 12:00:00 AM
SITE_LOCATION
20250 N STATEN ISLAND RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\tsok
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EHD - Public
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ayments - LexisNexis Payment Solutions Page 1 of 2 <br /> San Joaquin County Environmental Health <br /> 1868 E. Hazelton Ave. <br /> Stockton CA 95205 <br /> (209) 468-3420 <br /> Receipt <br /> Payment Date 02/25/2022 11:26 AM PST Payment Status AUTHORIZED <br /> Confirmation Number 139517072 <br /> Payment Method Credit Card (AMEX) ************1075 <br /> Expiration ##/## Transaction Type Purchase <br /> Approval Code 263415 <br /> AVS Response Y CVV2 Response M <br /> Rill To <br /> tyler harrison <br /> p.o. box 42 , Galt, CA - 95632 US <br /> Payment Towards <br /> Payment Towards Service Request Or Well <br /> y Permit Amount $304°00 <br /> Site Address N. Staten Island Rd. Business Name Valley Drilling <br /> Phone Number 2093692779 <br /> Charge Information <br /> Agency Amount $304.00 <br /> LexisNexis Service Fee $6.96 <br /> Total Amount 5310rt96 <br /> Print <br /> Your payment was made through paymentsolutions.lexisnexis.com, one of the LexisNexis VitalChek Network Inc. portals. <br /> For business or technical support, please send an email to paymentsolutions@lexisnexis.com. <br /> For San Joaquin County Environmental Health support, please call (209) 468-3420 <br /> LexisNexis, <br /> Home Payment Solutions Contact Us Terms and Conditions Privacy Policy <br /> IM [C—: TRUSTe <br /> https:/,payments.lexisnexis.com/billinglnfoConf.xhtml 2/25/2022 <br />
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