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vr�n vwrWVIIV I UUIIII T <br /> ENVIRONMENTAL HEALTH DEPARTME6 Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR • <br /> PTO 95202 COPY <br /> Phone:e: (209(209)46 468-3420 <br /> INVOICE Account ID —AR 00 118 4— <br /> Facility ID FA0001858 <br /> Date Printed2/28/2007 <br /> LEMONEUMMEMMUM <br /> BATNA, GURMEL RE : MY MINI MART <br /> MY MINI MART 1756 N WILSON WAY <br /> 7466 LAUREL CT STOCKTON, CA 95205 <br /> PLEASANTON, CA 94588 <br /> OWNER : BATNA, GURMEL <br /> Date Health <br /> Program Desription <br /> Amount <br /> Invoice# IN0157202---Date of Invoice: 1/25/2007 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII VIII VIII IIIIIIIIII IIIIIIIIIIIIII 11111111111 IIII IIII <br /> 1/25/2007 2220 SM HW GEN<5 TONS/YR $ 206.00 <br /> 1/25/2007 2244 2007 HAZMAT FEE PLUS 1 YEAR BACK BILLING $ 170.00 <br /> 1/25/2007 2301 UST STATE SURCHARGE FEE $ 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 2362 UST FACILITY& 1 TANK $ 500.00 <br /> 1/25/2007 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Involce $ 1,055.00 <br /> Payment Due Date 2/25/2007 <br /> SECOND N01TICE TOTAL DUE this Billing Period $ 5.00 <br /> PAYmT <br /> RECEIVED <br /> MAR 1 2 200 <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/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 />