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SAN.JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMW Page 1 <br /> •600 E MAIN STREET <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 / <br /> INVOICE "l � Account ID FA—ROO17813 <br /> Facility ID FA0010813 <br /> Date Printed 4/28/2011 y <br /> B AND G TRUCK WASH RE : B AND G TRUCK WASH <br /> 2904 CANYON DR 816 HWY 99 FRONTAGE RD <br /> MODESTO,CA 95351 RIPON, CA 95366 <br /> OWNER : SINGH,AMARJIT <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0211910---Date ofInvoice: 1/31/2011 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIVIIILVIIIVIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 270.00 <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 Penally Fee $ 27.00 <br /> Total for this Invoice $ 346.00 <br /> Payment Due Date 3/212011 <br /> TOTAL DUE this Billing Period $ 346.00 <br /> I�2)f VUE <br /> Delinquent charges <br /> willib�: f orward�ed to <br /> CLL <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 />