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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPART AT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> INVOICE A=unt ID ARooaloo, <br /> Facility ID FA0022402 <br /> Date Printed 7/1/2014 <br /> LUMOMMEMONNEENA <br /> COX, SAMMY RE : TSS <br /> TSS 6540 S AUSTIN RD <br /> <br /> <br /> OWNER : COX, SAMMY <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0254389---Date of Invoice: 711/2014 11p11pp11pIll Hill 11p1Pill pp1111p1p111p1111111MEfill 1p11Hill p111p1 <br /> 7/1/2014 1921 HMBP-Regular-Primary Location $ 285.00 <br /> Total for this Invoice $ 285.00 <br /> Payment Due Date 7/3112014 <br /> TOTAL DUE this Billing Period $ 285.00 <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 /> -_i1 rp1 <br />