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SAN JOAQUIN COUNTY ..i Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID ARo004629 <br /> LONOMMOMMEMEMS <br /> Facility to FA0002462 <br /> Date Printed 1/30/2014 <br /> NOR-CAL CHICKEN RE : EL POLLO LOCO #3307 <br /> EL POLLO LOCO#3307 678 N WILSON WAY STE 3 <br /> 1202 TULLY RD STE C STOCKTON, CA 95205 <br /> MODESTO, CA 95350 <br /> OWNER : NOR-CAL CHICKEN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0247496--Date of Invoice: 1/30/2014 111111111111111 IN 11111111111111 IN <br /> 1/30/2014 1921 HMBP-Regular-Primary Location $ 255.00 <br /> 1/30/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice I $ 290.00 <br /> Payment Due Date 3/1/2014 <br /> TOTAL DUE this Billing Period $ 290.00 <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 Rale 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 Dale 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> rpt <br />