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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPART JT <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Ph <br /> Account ID AR0016865 <br /> Facility 10 F FA0009865 <br /> Imommmommommoma <br /> Date Printed F 1/24/2005 <br /> lummmmmmmmomomm <br /> COUNTRY NISSAN RE : COUNTRY NISSAN <br /> 1515 N MAIN ST 1515 N MAIN ST <br /> MANTECA, CA 95336 MANTECA, CA 95336 <br /> OWNER : VINTAGE INVESTMENTS <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN01 28121 —Date of Invoice: 1/2412005 11111l1111Hill 11l1111II1111111iHill 111l11111I111I111111l1ll11l11111111INill! <br /> 1/24/2005 2220 SM HW GEN <5 TONS/YR $ 200.00 <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 Invoicel $ 354.00 <br /> Payment Due Date 2123/2005 <br /> TOTAL DUE this Billing Period $ 354.00 <br /> PAYMENT <br /> RECEIVED <br /> FEB 2 3 2005 <br /> SAN 3 AOUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 DES/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 he 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 />