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S jQA, QUIN COUNTY <br /> NVIRONMENTAL HEALTH DEPART r Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0003451 <br /> Facility ID FA0003863 <br /> Date Printed 1/24/2005 <br /> SHELL OIL PRODUCTS US RE : FREMONT SHELL* <br /> FREMONT SHELL* 2494 E FREMONT ST <br /> 20945 S WILMINGTON AVE STOCKTON, CA 95205 <br /> CARSON, CA 90810 <br /> OWNER : SHELL OIL PRODUCTS US <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0128365---Date of Invoice: 1/24/2005 I(IIIIII IIIIII III VIII VIII VIII VIII VIII Illll IIIII VIII VIII IIII IIIIII 11111 <br /> IIII Ilii <br /> 1/24/2005 2220 SM HW GEN <5 TONS/YR $ 200.001 <br /> 1/24/2005 2244 2005 HAZMAT FEE $ 130.00 <br /> 1/24/2005 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 354.00 <br /> Payment Due Date 2/23/2005 <br /> TOTAL DUE this Billing Period $ 354.00 <br /> ki-,PROVAL SIGNATURE. <br /> HEGEIVE- -SH&t <br /> APPROVAL ORTE - - - <br /> F)AYMENI �� ,U 2M 1NCID k <br /> RECEIVED ____ <br /> SCIENCE ENG 4VES?COAST >,OMPAt�IY CODE: E4UILC*+020 I <br /> MAR 1 U 2005 <br /> SAN JOACiUIN COUNTY <br /> CCOUNT CODE: 27"( <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> 30, DIST. <br /> Fto <br /> �Ampany Cod <br /> Cost Center _ _-��C�'G d <br /> Cost Element_ <br /> Approval �f <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 />