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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 Account ID AR0003195 <br /> LMMMMMEWEEMEN <br /> Facility ID FA0003617 <br /> Date Printed 1/29/2015 <br /> RICK CISSELL, MGR RE : CAL WEST CONCRETE CUTTINGS INC <br /> CAL WEST CONCRETE CUTTINGS INC 1153 VANDERBILT CIR <br /> 1153 VANDERBILT CIR MANTECA, CA 95337 <br /> MANTECA, CA 95337 <br /> OWNER : BIRCH,WELDON <br /> Date Health <br /> Program Description Amount l <br /> Invoice# IN0260211 ---Date of Invoice: 1/29/2015 IIIIIIIII IIVIIVIIIVIIVIIVIIIIIIIIIIIVIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 1/29/2015 1921 HMBP-Regular-Primary Location $ 315.00 <br /> 1/29/2015 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total othis Invoice $ 563.00 <br /> Payment Due Date 2/28/2015 <br /> TOTAL DUE this Billing Period $ 563.00 <br /> 9%7 <br /> 19.' D <br /> ,."� <br /> ENNJI1 t. nl`31 <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 100% <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 />