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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 18F8 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> Account ID AR0022600 <br /> INVOICE <br /> Facility ID FA0013644 <br /> Date Printed 4/26/2017 <br /> KHAN, SAFDAR RE : KHANS AUTO REPAIR&TOWING <br /> KHANS AUTO REPAIR &TOWING 720 E LODI AVE <br /> 720 E LODI AVE LODI, CA 95240 <br /> LODI, CA 95240 1 W <br /> OWNER KHAN, SAFDAR <br /> Hcalth ' <br /> Date Program Description Amount <br /> Invoice# IN0288542---Date of Invoice: 1/26/2017 I[III I III II I I VIII VII VII VIII VIII VI I IIIIIIIII V II[III VIII 11111 1111 IN <br /> 1/26/2017 2220 SM HW GEN<5 TONSNR $ 226.00 <br /> 1/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> 4/15/2017 9994 PERMIT FEE PENALTY $ 226.00 <br /> Total for this Invoice $ 487.00 <br /> P-4 A <br /> v9T ('� �.� Payment Due Date 2125/2017 <br /> WE VYGt1LCr PPPRECr,FTE YOUR TOTAL DUE this Billing Period $ 487.00 <br /> F^AY,Y.LNT TODAY[ <br /> W- <br /> I& � <br /> ry� <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 /> 5254.rpt <br />