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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTIV Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID ARO 018159 <br /> Facility ID FA0011159 <br /> Date Printed 11/22/2010 <br /> UTTERBACK, NANCY RE : SRUSURGICAL EXPRESS <br /> SRI/SURGICAL EXPRESS 6801 LONGE ST <br /> 6801 LONGE ST STOCKTON, CA 95206 <br /> STOCKTON, CA 95206 <br /> OWNER : SRI/SURGICAL EXPRESS <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0209411 ---Date of Invoice: 11/19/2010 11111 1111 111111 11111 1111 IN <br /> Hrs Employee <br /> 10/5/2010 2220 306-FOLLOW UP FOR NON-COMPLIANCE 0.50 NAIDU $ 61.00 <br /> Total for this Invoice $ 61.00 <br /> Payment Due Date 12/22/2010 <br /> TOTAL DUE this Billing Period $ 61.00 <br /> PAYMENT <br /> RECEIVED <br /> DEC 2 0 2010 <br /> EWR SAM JOAQUpN��Unry <br /> MEA TM ChblDFpgRMTA Hr <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 />