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SAN JOAQUIN COUNTY <br /> ENVIgONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAHLTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)4683420 <br /> INVOICE AccounlID AR0033046 <br /> LVEMEMMOMMMMOM <br /> Facility ID —F A-0 118664 <br /> LEEMMMMEMEMMA <br /> Date Pnnted 2/4/2015 <br /> DAVIS, TERRY RE : EAGLES NEST HARLEY DAVIDSON <br /> EAGLES NEST HARLEY DAVIDSON 13900 S HARLAN RD <br /> <br /> <br /> OWNER : DAVIS, TERRY <br /> Date Health <br /> 1 Program Description Amuunt <br /> Invoice# IN0262919---Date of Invoice: 1/2912015 IIIIIIIIIIIII VIII 111111111 IN <br /> 1/29/2015 1920 HMBP-Common Materials $ 100.00 <br /> 1/29/2015 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for iWis-liny-o-ic-e-1 $ 348.00 <br /> Payment Due Date 2/2812015 <br /> TOTAL DUE this Billing Period $ 348.00 <br /> b\-k5'1r1Q5S <br /> Toter` �uw\d / RY\dYe„� �esEbwo k <br /> E.0.gle5 ueg+ <br /> X3900 kA 4n Pd <br /> Q <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 />