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IAN JOAQUIN COUNTY PUBLIC&ALTH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DI ON 40 <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> 209-468-3420 <br /> INVOICE AccountlD AR0016341 <br /> LMMMOMMMOMA <br /> FA0009341 <br /> Facility ID <br /> Date Printed 2/1/01 <br /> JERRY MATTHEWS RE : HERMAN&HELEN'S MARINA <br /> HERMAN&HELEN'S MARINA 15135 W EIGHT MILE RD <br /> 15135 W EIGHT MILE RD STOCKTON CA 95219 20 <br /> STOCKTON CA 95219 OWNER: D SMITH,S WOODARD,J MATTHEWS <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0079819---Date of invoice: 1130/01 <br /> 1/30/2001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> 2/1/2001 2220 SM HW GEN<5 TONSNR $100.00 <br /> Total for this Invoice $110.00 <br /> Payment Due Date 200 <br /> TOTAL DUE this Billing Period $110.00 <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> enatieswi 11 bea a to all ermit Fees Fora <br /> F=— <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> PAYMENT <br /> RECEIVED <br /> FEB 2 12001 <br /> SAN JOAOUIN COUNTY <br /> PUBLIENVIRONrjFry HEALTH HEALTH DIVISION <br /> 5255.rpt <br />