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JNIV .tiUNh(VIIY l.VV1V 1 i <br /> ENVIRONMENTAL HEALTH DEPARTMMMr-NT Page 1 <br /> 304 E WEBER AVE -3RD FLOOR 40 <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE AccountlD AR1007692 <br /> Facility ID FA0006343 <br /> Date Printed 1/30/2006 <br /> LVaMxW9W <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 <br /> Amount <br /> Invoice# IN0143424---Date of Invoice: 1/27/2006 IIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIII VIII VIII IIIIIIIIIIIIIIIIIIII IIIIIIIIII 11111 11111111 <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR <br /> $ 200.00 <br /> 1/27/2006 2244 2006 HAZMAT FEE <br /> $ 85.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE <br /> $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE <br /> $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE <br /> $ 15.00 <br /> 1/27/2006 2360 ADDITIONAL UST <br /> $ 125.00 <br /> 1/27/2006 2360 ADDITIONAL UST $ 125.00 <br /> 1/27/2006 2362 UST FACILITY& 1 TANK <br /> $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoicel $ 1,104.00 <br /> Payment Due Date 3/ <br /> TOTAL DUE this Billing Period $ 1,104.00 <br /> PAYNI E <br /> RECEIVED <br /> FEB 13 2006 <br /> SAN JOAQUIN COUNTY <br /> LNVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> n <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 />