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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM- Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 9 <br /> <br /> AccountlD AR0016386 <br /> Facility ID FA0009386 <br /> Date Printed 1/30/200 <br /> FIELD TOWER SYSTEMS (KS SOLUTI RE : FIELD TOWER SYSTEMS (KS SOLUTIONS) <br /> PO BOX 504 28135 E COPPEROPOLIS RD <br /> ELVERTA, CA 956 6 FARMINGTON, CA 95230 <br /> OWNER : FIELD, DAVID <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0144369---Date of Invoice: /27/2006 IIIIIIII IIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIII IIII IIII <br /> 1/15/2006 9991 Credit Adjustment ($ 18.50) <br /> 1/27/2006 2220 SM HW GEN<5 TONS/YR $ -206: IV5i <br /> 1/27/2006 2244 2006 HAZ AT FEE $ 270.00 <br /> 1/27/2006 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> Total for this Invoice $ 475.50 <br /> Payment Due Date 3/1/2006 <br /> TOTAL DUE this Billing Period $ 475.50 <br /> sANFEe 1 7 2006 <br /> ENV SON '.UOUN <br /> HIT//p P4RTM <br /> NII <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 OES/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 /> 5254.rpt <br />