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SAN JUAI.lUIN I;UUN I Y <br /> Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 ®�Tj <br /> Phone: (209) 468-3420 \ i <br /> INVOICE a3 AccounttD AROWM03 <br /> Facility ID FA0014696 I <br /> F <br /> Date Printed F 4/28/2011 L <br /> V&J ORNAMENTAL IRON WORKS RE : V&J ORNAMENTAL IRONWORKS <br /> 1201 N FILBERT ST 1201 N FILBERT ST <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : VICTOR RIVARN I JAIME SALAS <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0212274--Date of Invoice: 1/31/2011 I VIII IIII III lull VIII VIII 111 VIII llll Ill/lull VIII III lllilllllllllll I11I <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 285.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/28/2011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 28.50 <br /> Total for this Invoice $ 362.50 <br /> Payment Due Date 3/2/2011 <br /> TOTAL DUE this Billing Period $ 362.50 <br /> I:� Qgg,"g tam,` "' L�� <br /> LJ 9"�2..;rn 3 <br /> DelingUent charges <br /> will be cnrWa'i C. ed to. <br /> s' 3 <br /> ir 30 days. <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> r <br /> nalties will be added to all Permit Fees For OES 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 /> 5254spt <br />