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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />INVOICE <br />MANTECA STAR LLC <br />CARLS JR #1575 <br />899 CHERRY AVE <br />SAN ERUNO, CA 94066 <br />Page 1 <br />Account ID <br />E AR0029427 <br />Facility ID <br />FA0016635 <br />Date Printed <br />7/10/2015 <br />RE: CARLS JR #1575 <br />1489 HULSEY WAY <br />MANTECA, CA 95336 <br />OWNER: MANTECA STAR LLC <br />Date Health <br />Program Description Amount <br />Invoice 9 IN0268369 --- Date of Invoice : 7/10/2015 11111 1111 111111 11111 IN IN <br />7/10/2015 1921 HMBP-Regular-Primary Location (2015 Billing) $ 255.00 <br />7/10/2015 1921 HMBP-Regular-Primary Location (2011-2014 Backbilling) $ 1,020.00 <br />Total forthis Invoice $ 1,275.00 <br />Payment Due Date 8/9/2015 <br />TOTAL DUE this Billing Period $ 1,275.00 <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 Pate 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 thereaft-ei <br />5254.rot <br />