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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPART& AT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID —AR-0 2-7 881 <br /> Facility ID FA0015749 <br /> Date Printed 2/28/2014 <br /> lummommommumwmmm <br /> ADAMS, DAVID RE : ADAMS AUTOMOTIVE <br /> ADAMS AUTOMOTIVE 1624 E ALPINE AVE <br /> STOCKTON, CA 95205 <br /> � b <br /> OWNER : ADAMS, DAVID <br /> Date Hgalth <br /> Program Description <br /> hrtrount <br /> Invoice# IN0249078...Date ofinvoice: 1/30/2014 111111111111111 IN <br /> 1/30/2014 1920 HMBP-Common Materials $ 100.00 <br /> 1/30/2014 2220 SM HW GEN <5 TONSNR $ 213.00 <br /> 1/30/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> r—Total forthis Invoice $ 348.00 <br /> WON IVaTICE Payment Due Date 3/1/2014 <br /> TOTAL DUE this Billing Period $ 348.00 <br /> PAYMENT <br /> RECEIVED <br /> P0APR 09 <br /> 4 C 0) \G �JOA 2O1y <br /> V V� ! W �I `V� 6./ ee Cyd` ENVIR", 00J <br /> NE1L111 OE�R rk", <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 HMBP 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 />