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SAN JOAQUIN COUNTY • • <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 v <br /> INVOIC COP ` Account ID AR0000379 <br /> 'rl Facility ID I FA0000380 <br /> Date Printed 2/1/2013 <br /> KMART#7486 V>- 31-I$)� rI 1 RE : KMART#7486 <br /> 3333 ero9�V.E,ERY RRAB,�Z�-"3A;Fk'rF+�I�T 520-S-CHEROKEE-LN -- -...... <br /> HOFFMAN ESTATES, IL 60179 LODI, CA 95240 <br /> OWNER : KMART <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0234886---Date of Invoice: 21112013 IIIIIIIII III VIIIVIII 1III11VI VIIIV IV 111111 IN 111111111111111 IN <br /> 2/1/2013 1921 HMBP-Regular-Primary Location $ 375.00 <br /> 2/1/2013 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 2/1/2013 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 623.00 <br /> Payment Due Date 3/312013 <br /> TOTAL DUE this Billing Period $ 623.00 <br /> RE FNED <br /> / h tg <br /> NEQ.iF/0 Aib'e q N) <br /> Please make Checks PAYABLE to: 'EHD' - Return a Copy of This STATEMENT with Your PAYMENT <br /> Penaltles will be added to all Permit Fees For DES I 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 />