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SAN JOAQUIN COUNTY + Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> INVOICE AccountlD ARools�sz <br /> Facility10 FA0012236 <br /> Date Printed 2/1/2013 <br /> KELLEY BROS BREWING CO RE : KELLEY BROS BREWING CO <br /> PO BOX 2466 112 E YOSEMITE AVE <br /> MANTECA, CA 95336-1165 MANTECA, CA 95336 <br /> OWNER : KELLEY, JOE N II <br /> Date Health Amount <br /> Program <br /> Invoice# 1140236581 ---Date of Invoice: 2/1/2013 VIII II VIVIIIV IVI VI II III VIII VIII IN 111111111111111 IIII <br /> 2/1/2013 1921 HMBP-Regular-Primary Location $ 315.00 <br /> 2/1/2013 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 350.00 <br /> Payment Due Date 31312013 <br /> TOTAL DUE this Billing Period $ 350.00 <br /> � f <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 OES/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 after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> <_«,1.., <br />