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SAN JOAQUIN COUNTY PUBLIC--r-`TH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DIV�� / <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> 209-468-3420 <br /> INVOICE Account ID 7R0017042 <br /> Facility ID FA0010042 <br /> Date Printed2/20/01 <br /> ANNE GAUTHIER RE : WINSTON TIRE CO#120 <br /> WINSTON TIRE CO#120 923 S CHEROKEE LN <br /> 900 W ALAMEDA AVE LODI CA 95240 20 <br /> BURBANK CA 91506 OWNER: OLIVER&WINSTON <br /> Health <br /> Date Program Description Hm Employee Amount <br /> Invoice# IN0080345—Date of Invoice: 1/30/01 <br /> 1/30/2001 2220 SM HW GEN<5 TONSNR $100.00 <br /> 1/30/2001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this invoice $110.00 <br /> Payment Due Date3/ <br /> TOTAL DUE this Billing Period 110.00 <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will e added to all ermit Fees Fora <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> PAYMENT <br /> RECEIVED <br /> FEB 2 0 2001 <br /> 5255.rpt <br />