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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMW Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID F'AR 00003 99 <br /> LEMOMMOMMUMA <br /> Facility ID FA0000360 <br /> Date Printed 6/25/2009 <br /> D 768 TAX, B2-113A RE : KMART#7486 <br /> KMART#7486 520 S CHEROKEE LN <br /> 3333 BEVERLY ROAD LODI, CA 95240 <br /> HOFFMAN ESTATES, IL 60179 <br /> OWNER : KMART <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0192743---Date of Invoice: 8/24/2009 111111111IIIIIIVII 111111111VI VI VIII VIII VIII IN 11111111111 III IN <br /> Hrs Employee <br /> 7/30/2009 2220 306-FOLLOW UP FOR NON-COMPLIANCE 0.50 HENRY $ 52.50 <br /> Total for this Invoicel $ 52.50 <br /> Payment Due Date 9/24/2009 <br /> TOTAL DUE this Billing Period E4 P2.50 <br /> PAYMENT <br /> RECEIVED <br /> SEP 14 2009 <br /> SAN JOAQUIN COUNTY <br /> EVIRONMENTHEALTH DE ARTMENT <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 DES/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 />