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SAN JOAQUIN COUNTY • <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 4683420 <br />INVOICE <br />BRIAN WEISS <br />FAMOUS DAVES <br />PO BOX 53696 <br />IRVINE, CA 92619 <br />Page 1 <br />Account ID <br />AR0033548 <br />Facility ID <br />FA0018871 <br />Date Printed <br />7/10/2015 <br />RE: FAMOUS DAVES <br />3170 NAGLEE RD <br />TRACY, CA 95304 <br />OWNER: SR RESTAURANT HOLDINGS GROUP <br />Date Health <br />Program Description Amount <br />Invoice # IN0268366 --- Date of Invoice : 7/1012015 I IIIIIII IIIIII III IIID ILII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br />7/10/2015 1921 HMBP-Regular-Primary Location (2015 Billing) $ 255.00 <br />7/10/2015 1921 HMBP-Regular-Primary Location (2011-2014 Backbilling) $ 1,020.00 <br />Total for this Invoice $ 1,275.00 <br />Payment Due Date 8/912015 <br />TOTAL DUE this Billing Period $ 1,275.00 <br />Please make Checks PAYABLE to: 'END' — Return a Copy of This STATEMENT with Your PAYMENT <br />'enalties 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 />