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ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE Page 1 <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0037754 <br /> Facility ID FA0020988 <br /> Date Printed 1/26/2017 <br /> JONES, RAY E RE : JONES, RAY E <br /> 10712 E MARIPOSA RD 10772 E MARIPOSA RD <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 <br /> OWNER : JONES, RAY E <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0290070--Date of Invoice: 1I26I2017 IIIIIIII IIIIIIIII VIIIIIIIIIIIIIIIIII VIII VIII VIIIIIIIIIIIII IIIIIIIIII VIII IIII IIII <br /> 1/26/2017 2220 SM HW GEN<5 TONS/YR <br /> 1/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 226.00 <br /> 1/26/2017 APSA APSA SURCHARGE $ 35.00 <br /> $ 26.00 <br /> Total for this Invoice $ 287.00 <br /> Payment Due Date2/25/2 7 <br /> TOTAL DUE this Billing Period $ .00 <br /> fo �� �. tY <br /> 01 IYU lie <br /> V� <br /> 6�aCA <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 />