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SAN JO,AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> Account ID AR0016944 <br /> INVOICE <br /> Facility ID FA0009944 <br /> Date Printed 9/27/2018 <br /> N&S IRRIGATION RE : N&S IRRIGATION <br /> PO BOX 805 215 W MAIN ST <br /> RIPON, CA 95366 RIPON, CA 95366 <br /> OWNER : JIM NICOLAY <br /> Date Health <br /> Program Description Amount <br /> i <br /> Invoice# IN0312413---Date of Invoice: 9/26/2018 111 11111 1111 1111 1�1�1 ITI 111 1111 111111 IEI IIII IN <br /> 9/26/2018 1920 HMBP-Common Materials $ 149.00 <br /> 9/26/2018 1922 CERS Processing Fee $ 30.00 <br /> 9/26/2018 2220 SM HW GEN<5 TONS/YR $ 249.00 <br /> 9/26/2018 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice $ 477.00 <br /> Payment Due Date 10/27/2018 <br /> TOTAL DUE this Billing Period $ 477.00 <br /> /lJ � -4 <br /> k113 uS/A/&S5 I-IX)S rit U.S� iI <� �> <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 /> i'_�/.rpt <br />