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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> Account ID AR0004282 <br /> INVOICE <br /> Facility ID FA0004538 <br /> Date Printed 9/29/2017 <br /> <br /> <br /> <br /> <br /> OWNER: KMART CORPORATION <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0297292---Date of Invoice: 9/26/2017 I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII 111111111 IIII <br /> 9/26/2017 1921 HMBP-Regular-Primary Location $ 432.00 <br /> 9/26/2017 1922 CERS Processing Fee $ 25.00 <br /> 9/26/2017 2220 SM HW GEN<5 TONS/YR $ 249.00 <br /> 9/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice $ 755.00 <br /> Payment Due Date 10/29/2017 <br /> TOTAL DUE this Billing Period $ 755.00 <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 HMBP 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 />