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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> INVOICE /y I� AccountlD AR00004�s <br /> Facility ID FA00 0-480 <br /> Date Printed F 4/30/2012 <br /> ROCKYS RESTAURANT RE: ROCKYS RESTAURANT <br /> PO BOX 2601 14659 N THORNTON RD <br /> LODI, CA 95241 LODI, CA 95242 <br /> OWNER : BENIGNO, BEVERLY <br /> Date Health <br /> Program Description Amount <br /> Involoa# IN0220265—Date of invoice: 101241701, llllli1111INllllllllllllllllll1 <br /> I Hrs Employee <br /> 9/13/2011 1626 333-INSPECTION/REINSPECTION(1 hr minimum) 1.00 LINHARES $ 125.00 <br /> 1/15/2012 9988 SERVICE CHARGE PENALTY $ 12.50 <br /> 211512012 9988 SERVICE CHARGE PENALTY $ 12.50 <br /> 3/1512012 9988 SERVICE CHARGE PENALTY $ 12.50 <br /> Total for this Involve $ 162.50 <br /> PAST DUE <br /> `)iivolce# IN0220661--Date of Invoice: 11/281011 IIIIIIII�lllllillullll�lllllllllllll"I� IAIIIII'III�IIIIIIIIIIIIIIIIIIIIIII <br /> Hrs Employee <br /> 1012612011 1626 334-INSPECTION I REINSPECTION-Set 101 ROUTIN 1.00 LINHARES $ 125.00 <br /> 2/1512012 9988 SERVICE CHAR 3E PENALTY $ 12.50 <br /> 3/15/2012 9988 SERVICE CHAR 3E PENALTY $ 12.50 <br /> 411512012 9988 SERVICE CHAR E PENALTY $ 12.50 <br /> Total for this Invoice 1 $ 162.50 <br /> PAST DUE <br /> Invoice# IN0224719—Date of Invoice: 1130120112 Iillllllllllll llllllll lull lull lllllllllllllll lull lllllllllllllllllllllllllllllllll <br /> 1127/2012 2244 2012 HAZMAT FEE $ 85.00 <br /> 1127/2012 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 1/27/2012 ERSC ELECTRONIC REPORTING STATE SURCHARGE FEE $ 25.00 <br /> 3/1512012 9987 Haz Mat Program Penalty Fee $ 8.50 <br /> j] �-��III r7 `� DUE <br /> [g�� Total for this Invoice $ 142.50 <br /> y3 11 ME 1 OQ <br /> PAST °" r e PAST DUE <br /> Delinquent charges <br /> WE WOULD APPRECIATE Y UR will be forty rdOTATPb DUE this Billing Period $ 467.50 <br /> PAYMENT TODAY! COLLECTIUNb <br /> in 30 days. <br /> Please make Checks PAYA LE to: 'EHD' – Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For DES/HMMP 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 akar the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />