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Sg,N J%AQUIN COUNTY <br /> +NVIRONMENTAL HEALTH DEPARTNj. Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0003419 <br /> Facility ID FA0003831 <br /> Date Printed 1/24/2005 <br /> �S�a'w11�C�V'-' c( <br /> SHELL OIL PRODUCTS US RE : WATERLOO SHELL* <br /> WATERLOO SHELL* 4315 WATERLOO RD <br /> <br /> <br /> OWNER : SHELL OIL PRODUCTS US <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0128675---Date of Invoice : 1/24/2005 I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <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 $ 2_4-00 <br /> Total for this Invoice $ / 524.00 <br /> Payment Due Date 2{212005 <br /> LAYMEN TOTAL DUE this Billing Period $ 524.00 <br /> REC'E�vE <br /> _ 3 2005 <br /> MAR _ APPROVAL SIGNATURE: <br /> SAN�OPO0\t'j NRECFNED •SH&E <br /> NL�NOEPPRSMEN� PROVAL DATE: <br /> FEB 01 2o05 i #: <br /> SCIENCE�,.ENG-NEST <br /> COMP LY CODE: E"ILCN_a201 <br /> #ev('f11!R!?CnnF: �7R5i11 <br /> ta _ . <br /> Company Code - 020 <br /> Cost Center <br /> Cost Element <br /> Approval <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 /> 5255.rpt <br />