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SAN JOAClUIN COUNTY Page 1 <br /> ENVIf16NMLNTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> COPYAccountlD AR0017934 <br /> INVOIC <br /> Facility ID FA0010934 <br /> Date Printed 10/31/2017 <br /> <br /> <br /> <br /> <br /> OWNER : ZAMORA AUTOMOTIVE GROUP <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0298478---Date of Invoice: 9/26/2017 11111111111111111111 IN 1111111111111111111 <br /> 9/26/2017 1921 HMBP-Regular-Primary Location $ 381.00 <br /> 9/26/2017 1922 CERS Processing Fee $ 25.00 <br /> 9/26/2017 2220 SM HW GEN<5 TONSNR $ 249.00 <br /> 9/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice $ 704.00 <br /> Payment Due Date 10/29/2017 <br /> TOTAL DUE this Billing Period $ 704.00 <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 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> s2s4.mt <br />