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SAN JOAQUIN COUNTY *.W Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET COPY <br /> STOCKTON, CA 95202 <br /> INVOICE L aa A,xnentlo F AR0035542 <br /> Facility ID FA0019963 <br /> Date Printed 4/30/2012 <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: 1/30/2012 IIIIIIIIIIIVIIIIIIIIIVIIILIIIIIIIIIIIiIIIIIIIIIIIIIIIIIIII <br /> 1/27/2012 2244 2012 HAZMAT FEE $ 100.00 <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 $ 10.00 <br /> Total for this Invoice $ 159.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 159.00 <br /> PASS DUE <br /> Delinquent Charges <br /> will be forwarded to <br /> COLLECTIONS <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 Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254 rpt <br />