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Page t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0017109 <br /> hg� Facility ID FA0010109 <br /> (C/✓✓ Date Printed S/27/ZOU9 <br /> RAMIREZ AUTOMOTIVE RE : RAMIREZ AUTOMOTIVE <br /> 811 N SACRAMENTO ST 811 N SACRAMENTO ST <br /> LODI, CA 95240 LODI, CA 95240 <br /> OWNER : JUAN RAMIREZ JR <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0184311 ---Date of Invoice : 1/29/2009 IIIIIIIIIIIIIIIIIIIIIIII IIIII�IIIIIVII VIIIVIIIVIIIII IIIIIIIIIII IN III <br /> 1/29/2009 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/29/2009 2244 2009 HAZMAT FEE $ 285.00 <br /> 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2009 9987 Haz Mat Program Penalty Fee $ 28.50 <br /> 4/15/2009 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 763.50 <br /> PAST DUE <br /> TOTALDUE this Billing Period $ 763.50 <br /> "� <br /> Will " (5lnfra(4 i :sk t0 <br /> 30 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 DES/HMNIP 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 />