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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0017470 <br /> Facility ID F FA0010470 <br /> Date Printed F 4/13/2006 <br /> ELEGANT SURFACES RE : ELEGANT SURFACES <br /> 551 CARNEGIE ST 551 CARNEGIE ST <br /> MANTECA, CA 95337 MANTECA, CA 95337 <br /> OWNER : POLIMENO, JOHN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0143040--Date of Invoice: 1/27/2006 IIIIIIIIIIIIIIIIIIIIIVIIIIIIIIIIIIIIIIillllllVIIIVIII11IIII'IIIIIII111II11111IN <br /> 1/27/2006 2220 SM HW GEN<5 TONSNR $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE $ 315.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 3/15/2006 9987 Haz Mat Program Penalty Fee $ 31.50 <br /> Total forthis Invoicel $ 570.50 <br /> Payment Due Date 311/2006 <br /> TOTAL DUE this Billing Period $ 570.50 <br /> lD <br /> b <br /> JAI C7 � <br /> L I <br /> OLI <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 />