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SAN JCAQUIN COUNTY • <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE Amount ID FAR0024356 <br /> Facility ID F FA0014332 <br /> Lonommmmommmm <br /> Date Printed 1/30/2014 <br /> CONNELL TIRE SERVICE CMATTIOLI, <br /> L TIRE SERVICE <br /> 1537 E MARKET ST ILSON WAY <br /> STOCKTON, CA 95205 ON, CA 95205 <br /> OW ANTHONY <br /> Healt,F, <br /> Date Program Description Amount <br /> Invoice# IN0248878--Date of Invoice: 1/30/2014 IIIIIIIIIIIIIIVIIIVIIVIVIVIIIIIIII VIII IIII IIIIII IIIII IIII IIII <br /> 1/30/2014 1921 HMBP-Regular-Primary Location $ 270.00 <br /> 1/30/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 305.00 <br /> Payment Due Date 311/2014 <br /> TOTAL DUE this Billing Period $ 305.00 <br /> IDD n6j Vj <br /> o0P <br /> AN\\1 <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 thereafter <br /> 5254.rpt <br />