Laserfiche WebLink
DAN JUTAWUIIV t UUN I T <br /> ENVIRONMENTAL HEALTH DEPARTMW a • Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR0007692� <br /> Facility ID FA0006343 <br /> Date Printed 1/26/2007 <br /> ALPHA FAST GAS* RE : ALPHA FAST GAS" <br /> 2358 E WATERLOO RD 2358 E WATERLOO RD <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : NGUYEN, LUU NGOC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0157257---Date of Invoice: 1/25/2007 11111 11111 11111 IN 111111 11111 1111 1111 <br /> 1/25/2007 2220 SM HW GEN <5 TONS/YR <br /> $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE <br /> $ 85.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE <br /> $ 15.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2360 ADDITIONAL UST $ 125.00 <br /> 1/25/2007 2362 UST FACILITY&1 TANK <br /> $ 500.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 1,110.00 <br /> Payment Due Date 2/,256007 <br /> TOTAL DUE this Billing Period $ 1,110.0,0Y' <br /> c-NE��--C- D <br /> SEB <br /> 5 2pOl <br /> GOU<`lN <br /> SAN��>a0NM�NSME�T <br /> SEA ZH nFPAR <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 OES/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 /> 5254.rpt <br />