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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />INVOICE <br />JOSE RAMIREZ <br />BROTHERS AUTO BODY & REPAIR <br />1130 E MAIN ST <br />STOCKTON, CA 95205 <br />Page 1 <br />Account ID <br />AR0035278 <br />Facility ID <br />FA0019818 <br />Date Printed <br />11/30/2017 <br />RE: BROTHERS AUTO BODY & REPAIR <br />1130 E MAIN ST <br />STOCKTON, CA 95205 <br />OWNER: RAMIREZ, JOSE <br />Date Health <br />Program Description Amount <br />Invoice # IN0300123 --- Date of Invoice : 9/26/2017 <br />9/26/2017 2220 SM HW GEN <5 TONS/YR <br />9/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />WEA" .'l n^F,:T"r';_ i3UR <br />FXG'*' N r iQL;AY! <br />IIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br />$ 249.00 <br />$ 49.00 <br />Total for this Invoice I $ 298.00 <br />Payment Due Date 10/29/2017 <br />TOTAL DUE this Billing Period $ 298.00 <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 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br />5254 rpt <br />