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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> Account ID AR0003575 <br /> INVOICE - nil <br /> Return This INVOICE with Your PAYMENT Facility ID FA0003961 <br /> Date Printed 5/24/2024 <br /> <br /> <br /> <br /> <br /> OWNER: CITY OF LODI <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0384141 ---Date of Invoice: 9125/2023 IIIIIIII IIIIII IIIIIIII VIII VIII IIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIII IIIIIIIIIII IIIIIIII <br /> 9/25/2023 1921 HMBP-Regular-Primary Location PR0520128 $ 646.00 <br /> 9/25/2023 1922 CERS Processing Fee PR0520128 $ 30.00 <br /> 9/25/2023 2220 SM HW GEN<5 TONS/YR PRO513833 $ 298.00 <br /> 9/25/2023 2301 UST STATE SURCHARGE FEE TA0133207 $ 20.00 <br /> 9/25/2023 2301 UST STATE SURCHARGE FEE TA0133208 $ 20.00 <br /> 9/25/2023 2301 UST STATE SURCHARGE FEE TA0133204 $ 20.00 <br /> 9/25/2023 2360 UST-PER TANK FEE TA0133208 $ 250.00 <br /> 9/25/2023 2360 UST-PER TANK FEE TA0133207 $ 250.00 <br /> 9/25/2023 2360 UST-PER TANK FEE TA0133204 $ 250.00 <br /> 9/25/2023 2361 UST FACILITY PR0231332 $ 1,178.00 <br /> 9/25/2023 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 84.00 <br /> 9/25/2023 APSA APSASURCHARGE PRO528447 $ 26.00 <br /> Total for this Invoice $ 3,072.00 <br /> Payment Due Date 10/30/2023 <br /> PAST DUE! <br /> Deliquent charges over <br /> 90 days! <br /> TOTAL DUE this Billing Period $ 3,072.00 <br /> V 0— & L6 i <br /> Please make Checks PAYABLE to: 'EHD' <br /> or <br /> Pay online at:' f <br /> Penalties will be added to all Permit Fees For HMBP 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 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt End of report <br />