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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 COPY <br /> Account ID AR0041208 <br /> INVOICE <br /> Facility ID FA0022528 <br /> CVIN,LLC <br /> 7447 N.PALM BLUFFS AVE ��s Date Printed 9/29/2017 <br /> Fresno,CA 93711-5773 <br /> CVIN-SAN JO IN COE RE : CVIN - SAN JOAQUIN COE <br /> SUSAN LA 2901 ARCH AIRPORT RD <br /> 9479 N F T WASHINGTON, STE. 105 STOCKTON, CA 95206 <br /> FRES , CA 93730 <br /> OWNER : CVIN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0300566—Date of Invoice: 9/26/2017 IIIII IIIIII III IIIII IIIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII 111111111 IIII <br /> 9/26/2017 1921 HMBP-Regular-Primary Location $ 313.00 <br /> 9/26/2017 1922 CERS Processing Fee $ 25.00 <br /> 9/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for thle Invoice $ 387.00 <br /> Payment Due Date 10/29/2017 <br /> TOTAL DUE this Billing Period $ 387.00 <br /> o- � <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 /> 5254.rpt <br />