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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT 111,4111, Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR000sssa <br /> Fadlay ID FA0006977 <br /> Date Printed 6/27/2011 <br /> KOMAL BROS INC RE : 76 EXPRESS TIGER NO 1 <br /> 76 EXPRESS TIGER NO 1 5777 S FRENCH CAMP RD <br /> 5777 S FRENCH CAMP RD STOCKTON, CA 95206 <br /> STOCKTON, CA 95206 <br /> OWNER : KOMAL BROS INC <br /> Date Health <br /> Program Description <br /> _ Amount <br /> Invoice# IN0217152...Date of Invoice: 5/25/2011 11111 HE 111111111111111111111111111111 IN 111111 IVI IIII IIII <br /> Him Employee <br /> 4/26/2011 2220 306-FOLLOW UP FOR NON-COMPLIANCE 0.50 RIVERA $ 61.00 <br /> 1 1` os ) -7 <br /> `LJI -77 D Total for this Invoice E 61.00 <br /> Payment Due Date 6/25/2011 <br /> TOTAL DUE this Billing Period $ 61.00 <br /> :GECOIND NOTi PAYMENT <br /> RECEIVED <br /> AUG —2 2011 <br /> ` so'oAQuN mu4T/ <br /> W'OHMENTAL <br /> KEALTH DEPARTME"' <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 OES/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 />