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SAN JOAQUIN COUNTY PUBLI ALTH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DIIWON is <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> 209-468-3420 <br /> INVOICE Account ID AR0003402 <br /> FA0003815 <br /> Facility ID <br /> Date Printed10/20/00 III <br /> C I DIAZ/USA GASOLIIRP RE : USA GASOLINE CORP#65 <br /> USA GASOLINE CORP 65 j 2500 W LODI AVE <br /> 30101 AGOURA CT LODI CA 95240 <br /> AGOURA HILLS CA 91301 <br /> OWNER: USA GASOLINE CORP <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0076603--Date of Invoice: 10/20/00 <br /> 10/20/2000 2220 SM HW GEN<5 TONS/YR $100.00 <br /> Totalforthis Invoice $100.00 <br /> Payment Due Date 11/1 <br /> TOTAL DUE this Billing Period $100.00 <br /> Please make Checks PAYABLE to: PHS/EHD / Returns 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 /> PAYMENT <br /> RECEIVED <br /> NOV 3 2000 <br /> SAN JOAOLAN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH UN6iUN <br /> 5255.rpt <br />