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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM "TPage 1 <br /> 600 t MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID RR0031987 <br /> Facility ID FA0018188 <br /> Date Printed 2/2/2010 <br /> SANDOVAL, HUMBERTO RE : A ONE AUTOMOTIVE REPAIR <br /> A ONE AUTOMOTIVE REPAIR 321 N STANISLAUS ST <br /> <br /> <br /> OWNER : SANDOVAL, HUMBERTO <br /> Health <br /> Date Program Description <br /> Amount <br /> Invoice IN0200573---Date ofInvoice: 2/2/2010 11111111111111 111111111111 <br /> 2/1/2010 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 100.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> Total for this Invoice $ 362.00 <br /> Payment Due Date 3/4/2010 <br /> TOTAL DUE this Billing Period $ 362.00 <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 DES/HMMP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10 <br /> 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> '_zJ rpt <br />