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SAN.JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMW • <br /> ,600 E MAIN STREET <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 7 <br /> t AR0035518 <br /> I NVOM E is ! � Account lD <br /> Facility ID FA0019939 <br /> Date Printed 412$12011 <br /> JASONS WHOLESALE RE : JASONS WHOLESALE <br /> 2540 STATION DR D 2540 STATION DR D <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 <br /> OWNER : JASON MATECKI <br /> date Health Amount <br /> Program Description <br /> Invoice# IN0213832---Date of Invoice: 1/31/2011 I1111111hill 111111111111111111111111111111111 VIII1111111111111[11111111111IN IIII <br /> 1/28/2011 2244 2011 HAZMAT FEE $ 315.00 <br /> 1/28/2011 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/2812011 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2011 9987 Haz Mat Program Penalty Fee $ 31.50 <br /> Total for this Invoice $ 395.50 <br /> Payment Due Date 3!2!2011 <br /> TOTAL DUE this Billing Period $ 395.50 <br /> formarded to, <br /> ODA <br /> Epi 30 d YS� <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 1 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 y <br /> I <br />