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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 />GSA GLOBAL SUPPLY <br /> <br /> <br />Page <br />Account ID <br />AR0028326 <br />Facility IDl <br />FA0016203 <br />MUM:. <br />Date Printed <br />1/29/2015 <br />RE: GSA GLOBAL SUPPLY <br />700 E ROTH RD BLDG <br />LATHROP, CA 95231-9735 <br />OWNER: GSA GLOBAL SUPPLY <br />Date Health <br />Program Description Amount <br />Invoice # IN0262082 --- Date of Invoice : 1/29/2015 <br />1/29/2015 1921 HMBP-Regular-Primary Location <br />1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />►NMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />1868 East Hazelton Avenue <br />Stockton, California 95205-6232 <br />Return Service Requested <br />11111111 I111I11111I11I 11I1I IMI 11111 I I1I11I11I 11I11111I111111111111111111111 IN 1111 <br />$ 375.00 <br />$ 35.00 <br />Total for this Invoice $ 410.00 <br />Payment Due Date 2/28/2015 <br />TOTAL DUE this Billing Period $ 410.00 <br />Mu D <br />Gsr\ C\ovvA S-Ak\,� cAGa< FEB 17 ?015 <br />Hasler <br />-,2/05/2101= <br />RM119PAIM <br />FIRST -CLAS P:IAIL <br />$00.402 <br />� 'AA.urro <br />1 D -1'-n0'-, <br />RETURN TO SE VDER <br />NOT DELI\1ERABLE AS ADDRESSED <br />UNABLE TO FORWARD <br />BC: 95205623258 *Z372 -®8751.-1<-Z8 <br />Hill j,1 111„1011111-111,W111111111iiIiiflidll ili ,,,,li}-� <br />-- --- <br />_ <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 Da•,r after the Invoice Date and each 30 Days thereafter <br />?54 mt <br />