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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTN T Page 1 <br /> 04 E WEBER AVE -3RD FLOOR <br /> TOCKTON, <br /> <br /> ountlD AR0003380 <br /> Facility ID FA0003795 <br /> Date Printed 1 2/27/2003 <br /> LIBERTY RURAL FIRE DISTRICT RE : LIBERTY RURAL FIRE DISTRICT <br /> 24124 N BRUELLA RD 24124 N BRUELLA RD <br /> ACAMPO, CA 95220 ACAMPO, CA 95220 <br /> OWNER : LIBERTY RURAL FIRE DISTRICT <br /> Date Health <br /> I Program DesCriptinn <br /> Amount <br /> Invoice# IN0103474—Date of Invoice: 2/27/2003 (� <br /> 2/27/2003 2220 SM HW GEN<5 TONS/YR $ 200.00 1�� <br /> 2/27/2003 2301 UST STATE SURCHARGE_ i $ _1_"0_ <br /> 2/27/2003 2301 UST STATE SURCHARGE <br /> 2/27/2003 2360 ADDITIONAL UST $ 125.00 <br /> 2/27/2003 2362 UST FACILITY& 1 TANK $ 500.00 <br /> 2/27/2003 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $ <br /> Total for this Invoice $ 862.50 �• <br /> Payment Due Date 3/29/2003 <br /> TOTAL DUE this Billing Period $ X862,50_ <br /> PAYMENT <br /> RECEIVED <br /> 2003 <br /> SFOBLICC HEATHS RVICES <br /> ENVIRON111EN <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 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 Days thereafter <br /> 5255 rpt <br />