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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />INVOICE <br />FRED F SMITH III <br />FRED SMITH QUALITY ROOFIN <br />24740 N. SOWLES ROAD <br />ACAMPO, CA 95220 <br />Page 1 <br />SMITH COATINGS, INC. <br />i <br />Account ID AR0016994 <br />126 Borth Houston Lane <br />Facility ID FA0009994 <br />Lodi, CA 95240: a <br />Date Printed 2/2/2016 -_ <br />RE: FRED SMITH QUALITY ROOFING&PAINTING <br />G 815 BLACK. DIAMOND WAY <br />LODI, CA 95240 <br />OWNER: FRED F SMITH III <br />Date Health <br />Program Description Amount <br />Invoice # IN0274834 --- Date of Invoice : 2/2/2016 <br />2/2/2016 1921 HMBP-Regular-Primary Location <br />2/2/2016 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />1111111111111 III VIII VIII II III III II VIII ����� VIII VIII <br />VIII IN <br />$ <br />111111 11111 1111 IN <br />345.00 <br />$ <br />35.00 <br />Total for this Invoice <br />$ <br />380.00 <br />Payment Due Date <br />3/3/2016 <br />$ <br />380.00 <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 HfVBP 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 thereaftei <br />5254.rpt <br />