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A <br /> .OUNTY <br /> .4TAL HEALTH DEPARTMENT Page 1 <br /> LELTON AVENUE <br /> (ON, CA 95205 <br /> -te: (209) 468-3420 <br /> Account ID AR0005843 <br /> INVOICELIMMOMMMOMMMMM <br /> Facility ID FA0005381 <br /> Date Printed 3/4/2015 <br /> 7-11 <br /> J LOMBARDI FARMS RE : J LOMBARDI FARMS <br /> 16998 E GAWNE RD 29665 KASSON RD <br /> STOCKTON, CA 95215 TRACY, CA 95376 <br /> OWNER : J LOMBARDI FARMS <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0260548---Date of Invoice: 1129/2015 IIIIIII IIIIII III IIIII IIIII IIIII IIIII IIIII IIIIIIIIII IIIII IIIII IIII IIIIII 111111111111 <br /> 1/29/2015 1958 HM-Famt Operations $ 18.00 <br /> 1/29/2015 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 266.00 <br /> INV"D Payment Due Date 2/28/2015 <br /> Invoice# IN0263714---Date of Invoice: 2/5/2015 MAR 16 2015 IIIIIII IIIIII III IIIII IIIII IIIII IIIII IIIIIIIIII IIIII IIIII1111111111111111111IIII <br /> 2/5/2015 APSA APSA SURCHARGE g1\1111MM"11 HEALTH <br /> Fy1�I�CES $ 26.00 <br /> PE61lNIT�S Total for this Invoice <br /> $ 26.00 <br /> Payment Due Date 3/8/2015 <br /> TOTAL DUE this Billing Periodi $ 292.00 <br /> /1 C C 0k,,jGO <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 />