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5AN JUAUUIN t;UUN I Y • Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> �� AR0016391 <br /> INVOICECOPY x AccountlD <br /> Facility ID FA0009391 <br /> Date Printed 5/30/2012 <br /> AMESSA AUTOMOTIVE CNTR RE : AMESSA AUTOMOTIVE CNTR <br /> 3943 N WEST LN 3943 N WEST LN <br /> STOCKTON, CA 95204-2435 STOCKTON, CA 95204 <br /> OWNER : JOSE PADILLA VILLA <br /> Date Health <br /> Amount <br /> Program Description <br /> Invoice# IN0223282--Date of Invoice: 113 012 01 2 IIIIIIIIIIIII III IIIIIIIIII VIII IIIIIIIIIIIII IIIIIIIIIIIIIIIIIII(IIIIIIIIII IIIIIIII <br /> 1/2712012 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 115.00 <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 $ 11.50 <br /> 4/15/2012 9994 PERMIT FEE PENALTY $ 213.00 <br /> Total for this Invoice $ 601.50 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 601.50 <br /> PAST DUE <br /> Delinquent charges <br /> will be forwarded to <br /> COLLECTOONS <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 OES/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 Dale 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br />