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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTII T <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />INVOICE <br />GSA GLOBAL SUPPLY <br /> <br /> <br />Page 1 <br />Account ID <br />I AR0028326 <br />Facility ID <br />7FA0016203,j <br />Date Printed <br />1/29/2015 <br />RE: GSA GLOBAL SUPPLY <br />700 E ROTH RD BLDG <br />LATHROP, CA 95231-9735 <br />OWNER: GSA GLOBAL SUPPLY <br />Date Health <br />Program Description Amount <br />Invoice # IN0262082 --- Date of Invoice : 1/29/2015 <br />1/29/2015 1921 HMBP-Regular-Primary Location <br />1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />I IIIIIII IIIIII III VIII VII I VIII VIII VIII VIII VIII VIII <br />VIII IIII <br />$ <br />IIIIII VIII IIII IIII <br />375.00 <br />$ <br />35.00 <br />Total for this Invoice 1 <br />$ <br />410.00 <br />Payment Due Date <br />2/28/2015 <br />$ <br />410.00 <br />TOTAL DUE this Billing Period <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 thereafte <br />5254.rpt <br />