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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account In AR0035542 <br /> Facdity to F FA0019963 <br /> Date Printed F-2/2912012 <br /> ULLOA'S TOW &AUTO REPAIR RE : ULLOAS TOW& AUTO REPAIR <br /> 620 S WILSON WAY STE C 620 S WILSON WAY STE <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : ULLOAS TOW &AUTO REPAIR <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0226249---Date of Invoice: 113012012 II I I III VIII I I I IV IVI VI I V/ VI 11111 11111111111111 IIII IIII <br /> 1127/2012 2244 2012 HAZMAT FEE S 100.00 <br /> 1/27/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE S 24.00 <br /> 112712012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> Total forth is Invoice $ 149.00 <br /> Payment Due Date 2/29/2012 <br /> TOTAL DUE this Billing Period $ 149.00 <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 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 /> 1214 rpt <br />