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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468.3420 <br /> Amount ID AR0021257 <br /> INVOICE NORCAL DIVISION <br /> ' Facility ID FA0012734 <br /> u S MAR 17 2014 <br /> Date Printed 2!26/2014 <br /> V ( ISKM,°NAGEMENT <br /> Q�'V�,Yt�txil=tti $�0� <br /> SAFEWAY, INC RE : SAFEWAY STORE 1769 <br /> 2808 COUNTRY CLUB BLVD <br /> 5918 STONERIDGE MALL RD. STOCKTON, CA 95204 <br /> ASANTON, CA 94588 <br /> OWNER : SAFEWAY, INC <br /> Date Health Amount <br /> Program Description <br /> IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIYIIlilt IIIIIIIIIIVIIIIIIIIIIIIV�Illnllllllllll <br /> Invoice# IN0246753—Date of invoice: 1/30/2014 <br /> 1/30/2014 1920 HMBP-Common Materials 0W1w ryy�1 $ 130.00 <br /> 1/30/2014 2220 SM HW GEN c5 TONS/YR r '�b'B • $ 213.00 <br /> 1/30/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for tMs Invoice $ 378.00 <br /> _ Payment Due Date 3/1/2014 <br /> SECONDNOTICE TOTAL DUE this Billing Period $ 378.00 <br /> 20 <br /> R"4 y4f�Nr <br /> (J B <br /> sor4 <br /> MqR? <br /> COU <br /> sa ?01 <br /> 22?—D <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 <br /> {930Days thereafter, <br /> 5254 rpt j tLja^` 55Z 13 6 <br />