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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTNhw4T <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />INVOICE <br />BURLINGTON STORE #571 <br />JUSTIN KANG <br />1830 ROUTE 130 NORTH <br />BURLINGTON, NJ 08016 <br />Date Health <br />Program Description <br />Invoice # IN0266188 --- Date of Invoice: 5/20/2015 <br />5/20/2015 2220 SM HW GEN <5 TONSNR <br />5/20/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />Page 1 <br />Account ID <br />�42064� <br />Facility ID <br />FA0022939 <br />Total for this Invoice $ <br />Date Printed f <br />5/20/2015 <br />u�. <br />RE: BURLINGTON STORE #571 <br />3702 E HAMMER LN <br />STOCKTON, CA 95212 <br />OWNER: BURLINGTON STORES <br />Amount <br />S <br />213.00 <br />S <br />35.00 <br />Total for this Invoice $ <br />248.00 <br />Payment Due Date <br />6/19/2015 <br />TOTAL DUE this Billing Period <br />$ <br />248.00 <br />Please make Checks PAYABLE to: 'EHD' <br />Return a Copy of This STATEMENT with Your PAYMENT <br />Eatth <br />will be added to all Permit Fees <br />ate of 100% of the Base Fee For HMBP Fees For all SERVICE FEES <br />Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% <br />Days after the Due Date 45 Days after the Invoice Date <br />60 Days after the Invoice Date and each 30 Days thereafter <br />.525-l.rpt <br />