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SAN JOAQUIN COUNTY rayc <br /> ENVIRONMENTAL HEALTH DEPARTME^IT <br /> 600E MAIN STREET COPY <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 1 O <br /> INVOICE 1 Account ID I AR0032996 <br /> Facility ID FA0018631 <br /> Date Printed 3/31(2010 <br /> CLEMENTS ROAD WINERY RE : CLEMENTS ROAD WINERY <br /> PO BOX 2818 11989 N CLEMENTS RD <br /> YOUNTVILLE, CA 94599 LINDEN, CA 95236 <br /> OWNER : JEFF LEBARD <br /> Date Health Amount <br /> Program Description <br /> Invoice If IN0200631 --Date of Invoice: 2/2/2010 ������IIIIIIIIIII IIIIIIIIII IIIII IIIII U1111111111111111111111111111111111111IN111I <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 285.00 <br /> 2/1/2010 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 $ 28.50 <br /> Total for this Involcel $ 362.50 <br /> Payment Due Date 314/2010 <br /> F TOTAL DUE this Billing Period $ 362.50 <br /> Delinquent c-harges <br /> will be fOrWarded to <br /> in Vit? aaVS, <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%r <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 />