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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 /> PLEASE MAIL INVOICE Account ID AR0003402 <br /> PERMIT TO <br /> BILLING ADDRESS Facility ID FA0003815 <br /> Date Printed 2/5/2002 <br /> r-I D1A2./U54 &AsouXt GARP <br /> USA GASOLINE CORP#65 RE: USA GASOLINE CORP#65 <br /> 30101 AGOURA CT STE 200 2500 W LODI AVE <br /> AGOURA HILLS CA 91301 LODI CA 95240 <br /> OWNER: KRISTMONT WEST,INC <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0090536--Date of Invoice: 1/22/2002 <br /> 1/22/2002 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $17.50 <br /> 1/2212002 2362 Underground Storage Tank EH Operating Permit Fee Tank#004 $500.00 <br /> 1/22/2002 2301 UST STATE SURCHARGE $10.00 <br /> 1/22/2002 2360 Underground Storage Tank EH Operatinq Permit Fee Tank#005 $125.00 <br /> 1/22/2002 2301 UST STATE SURCHARGE .00 <br /> 1/22/2002 2360 Underground Storage Tank EH Operating Permit Fee Tank#006 $$10$10.00 <br /> 1/22/2002 2301 UST STATE SURCHARGE $10.00 <br /> 1/22/2002 2360 Underqround Storage Tank EH Operating Permit Fee Tank#007 $125.00 <br /> 1/22/2002 2301 UST STATE SURCHARGE <br /> 1/22/2002 2220 SM HW GEN c5 TONS/YF 0.00 <br /> $200.00 <br /> Total for this invoice $1,132.50 <br /> Payment Due Date <br /> TOTAL DUE this Billing Period $1,132.50 <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 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 /> k�1.J CONjS E <br /> f ,inn <br /> ENS\PONM. <br /> 5255.rpt <br />