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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 />COATINGS, INC. <br />INVOIC ((SMITH <br />126 North Houston Lane <br />Lodi, CA 95240 <br />FRED F SMITH III RE <br />FRED'- T ALITY ROOFING <br />24740OAD <br />A, JM PO, CA 95220 <br />OWNER <br />Page 1 <br />Account ID AR00169994 <br />Facility ID FA000999s4..� <br />■�'''�/ V� Date Printed 1 2/2/2016 <br />F �SMITHQI��ROOFING8�PAINTING <br />815 BL WAY <br />LO <br />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 />IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII <br />$ <br />IIIIII VIII IIII IIII <br />345.00 <br />$ <br />35.00 <br />Total for this Invoice $ <br />380.00 <br />Payment Due Date <br />3/312016 <br />TOTAL DUE this Billing Period $ 380.0 <br />t <br />PAYMENT <br />RECEIVED <br />MAR 0 2 2016 <br />z `,N JOAQUIN COUNTY Q� <br />rl'ViAONMENTAL 3J` <br />"-I?a CEPARTMENT <br />Please make Checks PAYABLE to: 'EHD' - Return a Copy of This STATEMENT with Your PAYMENT <br />?enalties 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 />