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SAN,10A66IN COUNTY Pagel <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> i Phone: (209)468-3420 <br /> r <br /> INVOICEAR0030271 <br /> AccountlD <br /> Facility IQ TA0017389 <br /> Date Printed 1!30!2014 <br /> COOPER OUT WEST RE : COOPER OUT WEST <br /> 18636 E MILTON RD . 30783 RIVER RD <br /> LINDEN, CA 95236 ESCALON, CA 95320 <br /> OWNER : COOPER OUT WEST <br /> 4 <br /> Date, program Description Amount <br /> Invoice# IN0249713--Date of Involce: 113012014 I1111111111111IIIIIIII IIIIIIIIIIIIIII IIIII IIIII111111II11IN1III1111111111IIIII <br /> 1/30/2014 1958 HM-Farm Operations $ 18.00 <br /> 1/30/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 53.00 <br /> Payment Due Date 3/112014 <br /> I` TOTAL DUE this Billing Period $ 53.00 <br /> I <br /> 1 <br /> 4 <br /> t <br />+i <br /> y <br /> i <br /> j • <br /> Please make Checks PAYABLE to: 'EHD' - Return a Copy of This"STATEMENT with Your PAYMENT <br /> 1 Penalties will be added to all Permit Fees For HMBP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Sase 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 />