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SAN JOAQUIN COUNTYPage 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> ccount ID AR0022822 <br /> INVOICE v ' ►�' <br /> Facility ID FA0013665 <br /> nted 9/27/2018 <br /> DAVITA MANTECA DIALYSIS CENTER RE : DAVITA MANTECA DIALYSIS CENTER <br /> 1156 S MAIN'ST <br /> 5200 VIRGINIA WAY L&C DEPT MANTECA, CA 95336 <br /> BRENTWOOD, TN 37027 <br /> OWNER: D HEALTHCARE RENAL CARE, INC. <br /> Date Health <br /> Program Descriptign — Amount <br /> Invoice# IN0312746—Date of Invoice: 9/26/2018 I(111111 111111 111 lilll 11111 llllilllll 11[11 11111[1111[1111 11111 llll(Illll[1111 IIIIIIII <br /> 9/26/2018 1921 HMBP-Regular-Primary Location $ 347.00 <br /> 9/26/2018 1922 CERS Processing Fee $ 30.00 <br /> 9/26/2018 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice $ 426.00 <br /> Payment Due Date 1012712018 <br /> TOTAL DUE this Billing Period $ 426.00 <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 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpi <br />