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ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 <br /> INVOICE 1 ` Account ID A 111133 <br /> Facility ID FA0019671 <br /> Date Printed F 3/3112010 <br /> INNIMMMIUMMMMMMA <br /> JIM & MIKES PERFORMANCE AUTO RE : JIM & MIKES PERFORMANCE AUTO <br /> 820 S CALIFORNIA ST 820 S AMERICAN ST <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 <br /> OWNER : RUBEN RUBALCAVA <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0200820--Date of Invoice : 2/2/2010 i til ll ll l 1 11111 11 11 111111 /111111111 11111111111 IIII IIII <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 85.00 <br /> 2/112010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2010 9987 Haz Mat Program Penalty Fee $ 8.50 <br /> Total for this Invoice $ 142.50 <br /> Payment Due Date 314/2010 <br /> TOTAL DUE this Billing Period $ 142.50 <br /> Delinquent charges <br /> %AfiII be €erspfar bad io <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 DES I 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 />