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SAN JOAOUIN COUNTY PUBLIALTH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DI t ION <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> 209-468-3420 DICE AccountlD AR0003402 <br /> PLEASE MAIL <br /> PERMIT TOFA0003815 <br /> Facility ID Lummoommmmmmmmill <br /> BILLING ADDRESS <br /> Date Printed F 1/31/01 <br /> LMEMENNOMMOMIll <br /> C I 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 Hrs Employee Amount <br /> Invoice# IND079245--Date of Invoice: 1/30/01 <br /> 1/30/2001 2220 SM HVV GEN<5 TONS/YR $100.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2360 Underground Storage Tank EH Operating Permit Fee Tank#005 $125.00 <br /> 1/30/2001 2360 Underground Storage Tank EH Operating Permit Fee Tank#006 $125.00 <br /> 1/30/2001 2360 Underground Storage Tank EH Operating Permit Fee Tank#007 $125.00 <br /> 1/30/2001 2362 Underground Storage Tank EH Operating Permit Fee Tank#004 $500.00 <br /> 1/30/2001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $1,017.00 <br /> Payment Due Date 2 1 <br /> TOTAL DUE this Billing Period 1,017.00 <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 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 /> FEB 12 2001 <br /> SAN JOAQUIN COUNTY <br /> PUBLICO HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 5255.rpt <br />