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15AN JOAQUIN COUNTY <br />ENVIRONMENTAL hEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />Page 1 <br />Account ID AR0020263 <br />IIV\/OICE <br />�f G/D5rel Facility ID FA0012406 <br />Date Printed 1/26/2017 <br />WESTERN BUILDING MA �e1'fyf y /7(�J`/IG�D'C(J E: WESTERN BUILDING MATERIALS CO <br />462.0 E OLIVE AVE2401 STAGECOACH RD <br />1<2FRESNO, CA 93702 STOCKTON, CA 95215 <br />UwNER : WESTERN BUILDING MATERIALS CO <br />Date Health <br />Prooram Description Amount <br />Invoice # IN0288407 --- Date of Invoice : 1/26/2017 <br />1/26/2017 1921 HMBP-Regular-Primary Location <br />1/26/2017 1922 CERS Processing Fee <br />1/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />111111111111111111111111 <br />$ <br />IN III <br />374.00 <br />$ <br />25.00 <br />$ <br />35.00 <br />Total for this Invoice $ 434.00 <br />Payment Due Date 2/25/2017 <br />TOTAL DUE this Billing Period $ 434.00 <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 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 />525-1 rpt <br />