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SAN JOAOUIN COUNTY PUBLIC ALTH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON. CA 95202 <br /> 209468-3420 <br /> ntlD F AR0000913 <br /> FA0000916 <br /> Facility ID <br /> Date Printed 1/31/01 <br /> GASOLINE ACCOUNTING RE : 7 ELEVEN#19976* <br /> 7-ELEVEN INC 1399 N MAIN ST <br /> PO BOX 711 MANTECA CA 95336 <br /> DALLAS TX 75221 OWNER: 7-ELEVEN INC <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0079329--Date of Invoice: 1130101 <br /> 1/30/2001 2220 SM HW 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 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 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 Involcel $884.00 <br /> Payment Due Date <br /> TOTAL DUE this Billing Periodl $884.00 <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMEN <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 2 12001 <br /> SAKI nor oIm:;OUNTY <br /> r-uhuC 1 :11 r1,SEVVIGIS <br /> ENVIAl I.6i1 Ili DIJIS10N <br /> 5255.rpt <br />