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SAN JOAQUIN COUNTY / Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT COPY <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 n <br /> INVOICEy� 1 /] // AcccuntID AR0035527 <br /> `:.1 Facility ID FA0019948 <br /> Date Printed 4/30/2012 <br /> PAYLESS SMOG RE : PAYLESS SMOG <br /> 3227 E MAIN ST A 3227 E MAIN ST A <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : MARIA SERRATO <br /> Dale Heallh Amount <br /> Program Description <br /> Invoice# IN0226240--Date of invoice: 1/3 012 01 2 111111111 IN <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 85.00 <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 $ 8.50 <br /> Total for this Invoice $ 142.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 142.50 <br /> PAST DEE <br /> Delinquent Charges <br /> will be forwarded to <br /> COLLECT50NS <br /> in ;10 days. <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> f�,t <br /> lties will be added to all Permit Fees For DES/HMMP Fees For all SERVICE FEES <br /> 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 />