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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 COPY <br /> INVOIC Accountl0 FAR0030288 <br /> Facility I FA0017406 <br /> LOMMEMMMMMMOOM <br /> Date Printed 1/30/2014 <br /> HAL ROBERTSON FARMS LLC RE : HAL ROBERTSON FARMS LLC <br /> --27337 S-BANTA RDI .4,e� 1801 W LINNE RD <br /> TRACY, CA 95304 TRACY,CA 95304 <br /> OWNER: HAL ROBERTSON FARMS LLC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0249725--Date of Invoice: 1/3012014 11111111 IIIII111111111111111II E111111111111111111111111111111111 <br /> 1/30/2014 1958 HM-Farm Operations $ 18.00 <br /> 1/30/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 53.00 <br /> Payment Due Date 311/2014 <br /> TOTAL DUE this Billing Period $ 53.00 <br /> RECEIVED <br /> FED 14 2014 <br /> "1NJOAOU, <br /> ,ALTHOE A�sNry <br /> N <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 />