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ENVIRONMENTAL HEALTH DIVISION <br />'AESER AVENUE - 3RD '—')OR <br />A SOX 388 <br />'-TOCKTON, CA 95201-0388 <br />Accounting Office: 209 468-3420 <br />I.. C...a ., Co c::: c -P <br />TO: THREE PALMS GROCERY <br />2891 N ARATA RD <br />STOCKTON, CA 95205 <br />ATTN: BOZZANO, LINO <br />RE: THREE PALMS GROCERY <br />Report 15255 <br />Statement Printed: 12/18/96 <br />l <br />PLEASE RETURN a COPY of THIS STATEMENT with YOUR PAYMENT <br />Account # 0003669 <br />Facility ID 004030 <br />Service Activity <br />Date Description H r s Employee Amount <br />Invoice # 034663 -- Date of Invoice: <br />12/17/96 2360 UST Permit Fee <br />12/17/96 2360 UST Permit Fee <br />If this INVOICE has been Paid, Please Disregard this Notice . . . <br />12/17/96 <br />Tank # TA183002 $170.00 i <br />Tank # TA.183005 $170.00 <br />—— <br />Total for this invoice: $340.00 <br />Payment DUE DATE <br />OAYMENT <br />RECEI S-) <br />DEC 3 01996 <br />SAN JOAQUIN COUNT F <br />PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />PENALTIES for all FEES for SERVICE will be ASSESSED <br />PENALTIES will be ASSESSED on all ANNUAL PERMIT Fe at the rate of 10% of the Service Fee <br />at the rate of 101E of the Base fee 30 days after the Payment DUE DATE <br />30 days after the Payment DUE DATE. and EACH 31 days thereafter. <br />TOTAL DUE this Billing Period: $340.00 <br />Please Make CHECKS PAYABLE to: 1:" 11 c:3 /. EEE F-1 0:.1 <br />� y. <br />$0.00 - <br />$340.00 <br />0 to 30 days <br />31 to 60 days <br />61 to 90 days <br />91 to 120 days ) 126 days <br />Account <br />Balance <br />� y. <br />