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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> COPYAocountID AR0022800 <br /> INVOICE <br /> Facility ID F FA0013644 <br /> LMMMMOMMEWMA <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 <br /> OWNER : KHAN, SAFDAR <br /> Date Health Amount <br /> Program Description <br /> Invoice# IN0288642--Date of Invoice: 1/26/2017 11111/11 HIM III 1111111111111111111111111111111111111111111111111111111111111111111 <br /> 1/26/2017 2220 SM HW GEN<5 TONS/YR $ 226.00 <br /> 1/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> 4115/2017 9994 PERMIT FEE PENALTY $ 226.00 <br /> Total for this Invoice $ 487.00 <br /> f•- n — - �'+� i �"—' Payment Due Date <br /> 212512017 <br /> 'i:JUc. TOTAL DUE this Billing Period $ 487.00 <br /> FFA*'-:•c NT—10DAY I <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.mt <br />