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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTPOT <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0003195 <br /> Facility ID FA0003617 <br /> Date Printed 1/24/2005 <br /> RICK CISSELL, MGR RE : CAL WEST CONCRETE CUTTINGS INC <br /> CAL WEST CONCRETE CUTTINGS INC 1153 VANDERBILT CIR <br /> 1153 VANDERBILT CIR MANTECA, CA 95337 <br /> MANTECA, CA 95337 <br /> OWNER : BIRCH,WELDON <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0129501 ---Date of invoice: 1/2412005 IIIIIIIIIII III IIIIIIIII VIII VIII VIII IIIIIIIII VIII VIII IIII VIII VIII IIII III <br /> 1/24/2005 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 300.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 524.00 <br /> Payment Due Date 212312005 <br /> TOTAL DUE this Billing Period $ 524.0 <br /> PAYMENT <br /> RECEIVED <br /> JAN 2 8 2005 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 I 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 /> i2ii_rpt <br />