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SANJOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 EHAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0016875 <br /> Facility ID FA0009875 <br /> lonrAmmmonamme <br /> Date Printed 1/29/2015 <br /> FORD CONSTRUCTION COMPANY, INC. RE : FORD CONST CO INC <br /> FORD CONST CO INC 500 N CLUFF AVE <br /> 639 E LOCKEFORD ST LODI, CA 95240 <br /> LODI, CA 95240 <br /> OWNER : BOB JONES <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0261123---Date of invoice: 1/29/2015 1111111111 ME IN 1111111111111111111 <br /> 1/29/2015 1921 HMBP-Regular-Primary Location $ 360.00 <br /> 1/29/2015 2227 GEN 5<25 TONS PERMIT $ 1,672.00 <br /> 1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> 1/29/2015 2832 AST FAC 10 K-</=100 K GAL CUMULATIVE $ 675.00 <br /> 1/29/2015 APSA APSA SURCHARGE $ 26.00 <br /> Total for this Invoice $ 2,768.00 <br /> Payment Due Date 2/28/2015 <br /> TOTAL DUE this Billing Period $ 2,768.00 <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 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />