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::. <br /> SAN JOAQUIN COUNTY • <br /> ENVIRONMENTAL HEALTH DEPARTMEV Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> INVOIC ropy �/�' � Account ID AR0017776 <br /> l• � Facility ID FA0010776 <br /> Date Printed 5/30/2012 <br /> J&M TRANSMISSION INC RE : J&M TRANSMISSION INC <br /> 7944W 11TH ST#F 7944 W 11TH ST F <br /> TRACY, CA 95304 TRACY, CA 95304-9303 <br /> OWNER : MAURICIO URTEAGA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0223630---Date of Invoice: 1/30/2012 1111111111111 <br /> 1/27/2012 <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 100.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/15/2012 9987 Haz Mat Program Penalty Fee $ 10.00 <br /> 4/15/2012 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 585.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Periold $ _ 585.00 <br /> PAST DUE <br /> [Delinquent charges <br /> will be forwarded to <br /> COLLECTIONS <br /> in 30 days. <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/HMMP Fees For all SERVIC=30Days <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% Penalties will be added <br /> 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date aneafter <br />