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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPART,_AT <br /> 1868 E HAZELTON AVENUE / . <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0032270 <br /> LUMMONOMMMEMOM <br /> Facility ID -F A-0-0 8-320 <br /> Date Printed 2/20/2014 <br /> SAVE MART SUPERMARKETS RE : SAVE MART#100 <br /> SAVE MART#100 t/ 1453 GOODWIN DR <br /> 1800 STANDIFORD AVE:Y6 rk'" L441'LI RIPON, CA 95366 <br /> MODESTO, CA 95350 `2ri5S2 <br /> OWNER : SAVE MART SUPERMARKETS <br /> Date Health <br /> Program Description <br /> Amount � <br /> Invoice# IN0250607---Date of Invoice: 2/20/2014 III I II I I V I VIII V V I VI V I VII V I VIII IIII 111111 VIII IIII IIII <br /> 2/20/2014 1921 HMBP-Regular-Primary Location $ 315.00 <br /> 2/20/2014 2220 SM HW GEN<5 TONSNR $ 213,00 <br /> 2/20/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for th is Invoice $ 563.00 <br /> Payment Due Date 3/22/2014 <br /> TOTAL DUE this Billing Period $ 563.00 <br /> PAYMENT <br /> RECEIVED <br /> MAR 0 7 20% <br /> SAN JOAO' <br /> Please make Checks PAYABLE to: 'EHO' – 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 /> rpt <br />