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SAN JOAQUIN COUNTY • Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> O <br /> iNvoice AccountlD AR0016839 <br /> COPY ��� <br /> Facility ID FA0009839 <br /> Date Printed 5/30/2012 <br /> WEST LANE RADIATOR RE : WEST LANE RADIATOR <br /> 3941 N WEST LN 3941 N WEST LN <br /> STOCKTON, CA 95204 STOCKTON, CA 95204 <br /> OWNER : FORTUNE,JAMES <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0223420---Date of Invoice: 1/30/2012 IIIIIIIIIIIIIIIIIIIIIIIIVIIIVIIVIII IIIIIIIIIIIIIIIIIIIIIIVIIIIIIIIII <br /> 1/27/2012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 330.00 <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 /> 3/1512012 9987 Haz Mat Program Penalty Fee $ 33.00 <br /> 4/15/2012 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 838.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 838.00 <br /> PAST DUE <br /> Delinquent charges <br /> Will be forwarded to <br /> COLLECTRONS <br /> in 3® 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/HMMP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties wil I be added at the Rate of I e% 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 />