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.ENVIRONMENTAL HEALTH DEPARTMO • <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 RECEIVED <br /> INVOICE JUL 31 2012 Account ID AR0018279 <br /> ( J' ENVIRONMENT Facility ID FAO011279 <br /> / HEALTH DEPARTMENTAL <br /> Date Printed 7/31/2012 <br /> CUSTOM METAL FINISHING RE : CUSTOM METAL FINISHING <br /> 1550 SHAW RD#C 1550 SHAW RD C <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 <br /> OWNER : CUSTOM METAL FINISHING <br /> Date Health <br /> Program Description Amount <br /> Invoice# IND223693---Date of Invoice: 1/3012012 111111111111111111111111111111 IN 111111111111111 IN <br /> 1/27/2012 2227 GEN 5<25 TONS PERMIT $ 1,672.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 360.00 <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 $ 36.00 <br /> 4/15/2012 9994 PERMIT FEE PENALTY $ 1,672.00 <br /> Total for this Invoice 1 $ 3,789.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 3,789.00 <br /> PAST DUE <br /> Delinquent charges <br /> will be forwarded to <br /> COLLE?CIIONS <br /> in 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 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 />