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USAN JOAQUIN COUNTY PUBLIC LTH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DI"WN • <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> 209-468-3420 <br /> INVOICE Account ID AR0003402 <br /> OFA0003815 <br /> _ Facility ID <br /> M <br /> j/ Date Printed 10/20/00 <br /> C 1 DIAZ/USA GASOLINE CORP RE : USA GASOLINE CORP#65 <br /> USA GASOLINE CORP#65 2500 W LODI AVE <br /> 30101 AGOURA CT LODI CA 95240 <br /> AGOURA HILLS CA 91301 OWNER: USA GASOLINE CORP <br /> Health <br /> Date Program Description Firs Employee Amount <br /> Invoice# IN0076603.—Date of Invoice: 10120/00 <br /> 10/20/2000 2220 SM HW GEN<5 TONSNR $100.00 <br /> Total for this Invoice $100.00 <br /> Payment Due Date 11119/2000 <br /> TOTAL DUE this Billing Period 100.00 <br /> Please make Checks PAYABLE to : PHS/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 Penaltieswill 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 /> �'4 /` <br /> 5255.rpt <br />