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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTP -IT /\ Page 1 <br /> 104'E'WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 h/ <br /> Phone: (209)468-3420 <br /> INVOICE Account l0 FAR0004604 <br /> FacilitylD F FA0002409 <br /> LNEENOMMOMMMIll <br /> Date Printed 4/20/2005 <br /> INEENMENEENMEMM <br /> SAFEWAY FUEL CENTER �RE/l: SAFEWA U ENT �,pj p <br /> <br /> STOCKTON, CA 95207 <br /> OWNER : SAFEWAY INC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0132109—Date of Invoice: 412012005 IIIIIIIIIIIII VIVIIIIIIIIIIIVIIVIIVII VIIIVIII IIII IIIIII VIIIIIII IIII <br /> 4/20/2005 2220 SM HW GEN<5 TONSNR $ 200.00 <br /> Total for this lnvolce $ 200.00 <br /> Payment Due Date 5/20/2005 <br /> TOTAL DUE this Billing Period $ 200.00 <br /> A,�MEN D <br /> 60VE <br /> ��t� 1`0 2p05 <br /> SPPENOVIAP NME�jNIWE <br /> H�tH pEPAA <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 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 />