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.7AN JUAUUIN L UUN I T rayc <br /> ENVIRONMENTAL HEALTH DEPARTME'-_ <br /> 304 E WEBER AVE -3RD FLOOR ' <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 <br /> I N V OI L E Account lD AR0003451 <br /> Facility ID300AF 0 863 <br /> Date Printed r- 1/30/2006 <br /> DOMINGUEZ, MICHAEL RE : FREMONT SHELL* <br /> FREMONT SHELL* 2494 E FREMONT ST <br /> 2494 E FREMONT ST STOCKTON, CA 95205 <br /> STOCKTON, CA 95205 <br /> OWNER : DOMINGUEZ, MICHAEL <br /> Date Health <br /> Program Description ++I))Ij ff I Amount <br /> Invoice# IN0143085--Date of Invoice: 1127/2006 �Ilil�l IIIIIi IIS I�III ILII lII��IIIIi IIliI IIIII IIII!IIIII I1III1111II IN!lull!111111'111111 <br /> 1127{2rPF 2220 SM HW GEN <5 TONS/YR $ 200.00 <br /> 1127/2006 2244 2006 HAZMAT FEE $ 130.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2301 UST STATE SURCHARGE FEE $ 15.00 <br /> 1/27/2006 2350 ADDITIONAL UST-2481 COMPLIANT $ 12.5.00 <br /> 1/27/2006 2352 UST FACILITY& I TANK.2481 COMPLIANT $ 500.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for thls Invoice $ 1,009.00 <br /> Payment Due Date <br /> TOTAL DUE this Billing Period $ 1,009.00 <br /> L/ <br /> h�aR i 2006 <br /> _SA[l JOi10'JIP:COURT',' <br /> ENVIRONMENTAL <br /> HEALTH DEPA.RTMENT <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 I 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 Dwe 60 Days after the Invoice Date and each 30,Days thereafter <br /> 5254.rpt <br />