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Y f <br /> SAN JOAQUIN COUNTY • • Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE AccounIID AR0029142 <br /> LONEEMMMMOMMA <br /> FacilityID FA0016538 <br /> Date Printed 1 1/30/2014 r/ <br /> pais.Wu rh5 ��fff`v' Y\ <br /> SAVE MART SUPERMARKETS / RE : SAVE MART#94 v1SAVE MART#94 15240 S HARLAN RD <br /> 1 . f U lw 4coN LATHROP, CA 95330 <br /> MODESTO,CA 95356' <br /> OWNER : SAVE MART SUPERMARKETS <br /> Date Ilealth <br /> Program Description Amount <br /> Invoice# IN0249157--Date of Invoice: 1130/2014 1111111111111111111111111111 <br /> 1/30/2014 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/30/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 248.00 <br /> Payment Due Date 3/112014 <br /> TOTAL DUE this Billing Period $ <br /> PAYMENT <br /> RECEIVED <br /> FEB 19 2014 <br /> SAN JOAOUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMEln <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 />