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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E HAZEL T ON AVENUE <br />STOCt,. r ON, CA 95205 <br />Phone: (209) 468-3420 <br />INVOICE <br />HORMEL FOODS CORPORATION <br />HORMEL FOODS CORP <br />PO BOX 100 <br />STOCKTON, CA 95201 <br />Page 1 <br />Account ID <br />Uj <br />AR0016519 <br />Facility ID <br />FA0009519 <br />Date Printed <br />2/2/2016 <br />RE: HORMEL FOODS CORPORATION <br />1404 S FRESNO AVE <br />STOCKTON, CA 95206 <br />OWNER: HORMEL FOODS CORP <br />Date Health <br />Prowsm Description Amount <br />Invoice # IN0274673 --- Date of Invoice : 2/2/2016 <br />2/2/2016 1921 HMBP-Regular-Primary Location <br />2/2/2016 2220 SM HW GEN <5 TONSNR <br />2/2/2016 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />x'W 45 <br />/la,-Ael malls <br />Pd 3C)41 goo <br />IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII <br />VIII IIII <br />$ <br />IIIIII VIII IIII III <br />270.00 <br />$ <br />213.00 <br />$ <br />35.00 <br />Total for this Invoice <br />$ <br />518.00 <br />Payment Due Date <br />3/3/2016 <br />$ <br />518.00 <br />TOTAL DUE this Billing Period <br />Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br />3enalties 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 thereafte <br />5254.rpt <br />