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SAN JOAOUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> Phone: 209-468-3420 <br /> INVOICE Account ID AR0018876 <br /> Facility ID FA0009876 <br /> Date Printed 2/6/2002 <br /> BLAINE J DEJONG RE: BLAINE DEJONG'S AUTO WORKS INC <br /> BLAINE DEJONG'S AUTO WORKS INC 324 N CLUFF AVE <br /> 324 NCLUFF AVE LODI CA 95240 20 <br /> LODI CA 95240 OWNER: BLAINE DFJONG'S AUTO WORKS INC <br /> Health <br /> Date Program Description Hm Employee Amount <br /> Invoice# IN0091459—Date of Invoice: 112212002 <br /> 1/22/2002 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $17.50 <br /> 1122/2002 2220 SM HW GEN<5 TONSNF $200.00 <br /> Total for this Invoice $217.50 <br /> Payment Due Date 3182002 <br /> TOTAL DUE this Billing Period 217.50 <br /> Please make Checks PAYABLE to: EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will he added to all Permit Fees For all SERVICE FEES <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 /> PAY <br /> RECEIVED <br /> MAR052v <br /> SAN JOAQUIN COUNTY <br /> PUBLIC ENVIRONI IFNTAj HEAL THWo;ES IDN <br /> 5255.rpt <br />