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i <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />INVOICE <br />COCKRUM,ROD <br />DICKEYS BARBECUE PIT <br />1230 EDGEWOOD DR <br />LODI, CA 95240 <br />Page 1 <br />Account ID <br />AR0032761 <br />Facility ID <br />�mm FA0018524 <br />Date Printed <br />7/10/2015 <br />RE: DICKEYS BARBECUE PIT <br />1446 HULSEY WAY <br />MANTECA, CA 95336 <br />OWNER: 4 U SMC INC <br />Date Health <br />Program Description Amount <br />Invoice # IN0268364 --- Date of Invoice : 7/10/2015 I IIIIIII II III' l Ill�l I�III VIII VIII VIII III I' III VIII 11111 1111 IIIIII VIII IN I'll <br />7/10/2015 1921 HMBP-Regular-Primary Location (2015 Billing) $ 255.00 <br />7/10/2015 1921 HMBP-Regular-Primary Location (2014 Backbilling) $ 255.00 <br />Total for this Invoice $ 510.00 <br />Payment Due Date 8/9/2015 <br />TOTAL DUE this Billing Period $ 510.00 <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 />5154 '-"t <br />