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SANk-OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMof • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR00166 4— <br /> Facility ID FA0009644 <br /> LUMMOMMUNNOMMOM <br /> Date Printed 1/24/2005 <br /> EMMENOMMOMMENOMMM <br /> COX BROS TIRE SERVICE RE : COX BROS TIRE SERVICE <br /> 507E 11TH ST 507 E 11TH ST <br /> TRACY, CA 95376 TRACY, CA 95376 <br /> OWNER : EARL BREITSTEIN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0129254--Date of Invoice: 1/24/2005 11111111111111111111111111111111111111 <br /> 1/24/2005 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 100.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total forth is Invoice I $ 324.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period $ 324.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 1 7 2005 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 /> 5255.rpt <br />