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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMF"T <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> INVOICE Account ID AR0025003 <br /> Facility ID FA0014696 <br /> Date Printed 5/30/2012 <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/JAIME SALAS <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0224722—Date of Invoice: 1/3012012 IIIIIIIIIIIiIIVIIIVIIIVIIVIIIIIIIIIIIIIVIIIVIIIVIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 285.00 <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 $ 28.50 <br /> Total for this Invoice $ 362.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 362.50 <br /> MA <br /> F f—i .•" D P 14 <br /> WE WOUI-n AF.'RL ':r,TE YOUR <br /> PAYUiENT TUDX-1 <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 1 HMMP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties yKW 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 /> i254 rpt __. ...... <br />