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SAN,IOAOUIN C U TY PUBLIC. .ALTH SERVICES Page 1 <br /> ENVIRONMEN-II'44,L HEALTH DIVISION <br /> 304 E WEBER ANJE- RD FLOOR <br /> STOCKTON. CAI 95 '02 <br /> 209-468-3420 <br /> INVOICE Account ID AR0003179 <br /> FA0003601 <br /> �{/�n� Facility ID <br /> f1/MVV Date Printed 1/31/01 <br /> ENVIRONMENTAL HEALTH& SAFETY RE : ARCO STATION#5469* <br /> WIGHT,COLLINS 130 S WILSON WY <br /> PO BOX 6038 STOCKTON CA 95205 <br /> ARTESIA CA 907026038 <br /> OWNER: WIGHT,COLLINS <br /> Health <br /> Date Prugram Description Hrs Employee Amount <br /> Invoice# IN0079384---Date of Invoice: 1/30/01 <br /> 1/30/2001 2220 SM HW GEN<5 TONSNR $100.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2301 UST STATE SURCHARGE $8.00 <br /> 1/30/2001 2360 Underground Storage Tank EH Operating Permit Fee Tank#002 $125.00 <br /> 1/30/2001 2360 Underground Storage Tank EH Operating Permit Fee Tank#003 $125.00 <br /> 1/30/2001 2362 Underground Storage Tank EH Operating Permit Fee Tank#001 $500.00 <br /> 1/30/2001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $884.00 <br /> Payment Due Date /2001 -- <br /> TOTAL DUE this Billing Period 884.00 <br /> Please make Checks PAYABLE to: PHS/EIID / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> PAYNI'._+' <br /> RECEI\'_ <br /> (tF <br /> E B 0 7 1001 SAN JUAOU: ; <br /> PUBLIC HEN I J'' <br /> -- ENVIRONNIFNTAi <br /> Oris '. QMP�-i <br /> . A <br /> Otto <br /> 5255.rpt �J � <br />