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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> Account ID AR0042061 <br /> INVOICE ,, <br /> Facility ID FA0022936 <br /> Date Printed 5/20/2015 <br /> VERIZON WIRELESS RE : VERIZON WIRELESS QUESTA VILLAGE <br /> ENVIRONMENTAL COMPLIANCE 18045 S KELSO RD <br /> 255 PARKSHORE DRIVE MOUNTAIN HOUSE, CA 95391 <br /> FOLSOM, CA 95630 <br /> OWNER : VERIZON WIRELESS <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0266191 ---Date of Invoice: 512 012 01 5 II' l l 'I II II III I II ' I� I II II�I II I f '1111111111111111111 <br /> 5/20/2015 1921 HMBP-Regular-Primary Location S 270.00 <br /> 5/20/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 305.00 <br /> Payment Due Date 611 912 01 5 <br /> TOTAL DUE this Billing Period $ 305.00 <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 />