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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> INVOICE AccountlD AR0017400 <br /> Facility ID FA00 00400 <br /> Date Printed 2/1/2013 <br /> O'REILLY AUTO PARTS#2765 RE : O'REILLY AUTO PARTS#2765 <br /> 3207 GREY HAWK STE 200 I, CHEROKEE LN <br /> CARLSBAD, CA 920101 LO0 LODI, CA 95240 <br /> OWNER : ;GIGS-ALIT tR1C / O <br /> CS 1- AvCO lWC-- J W <br /> Health <br /> """ Program Desu ip6un Amount <br /> Invoice# IN0236324---Date of Invoice: 21112013 11111111111111111111 IN 111111111111111 IN <br /> 2/1/2013 1921 HMBP-Regular-Primary Location $ 315.00 <br /> 2/1/2013 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 2/1/2013 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total fora Invoice $ 563.00 <br /> Payment Due Date --x/3/2013 <br /> TOTAL DUE this Billing Period $ 563.00 <br /> PA ENT <br /> RECE <br /> FEB 2 8 2013 <br /> SAN JOAOUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 OES/HMMP 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 />