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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMEO • <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209) 468-3420 , .3 1 a <br /> INVOICE d\ Account ID r AR0035029 <br /> Facility ID F FA0019667 <br /> Date Printed 3/31/2010 <br /> LEWANUMMMENWA <br /> PERFORMANCE MACHINE RE : PERFORMANCE MACHINE <br /> 11667 PALM LN UNIT F 11667 PALM LN UNIT <br /> MANTECA, CA 95336 MANTECA, CA 95336 <br /> OWNER : WALT OTT <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0200816---Date of Invoice: 2/2/2010 IIIIIIIIIIIIII VIII VIIIIIIIIVIIIIIIVIIIVIIIVIIIVIIIIIIIIIVIII IIIIII <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 270.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2010 9987 Haz Mat Program Penalty Fee $ 27.00 <br /> Total for this Invoice $ 346.00 <br /> Payment Due Date 3/412010 <br /> TOTAL DUE this Billing Period $ 346.00 <br /> I 1 LhUE- <br /> Delinquent charges <br /> will be forwarded tc <br /> in SO 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 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 46 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />