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'A COUNTY <br /> eENTAL HEALTH DEPARTMEND Page 1 <br /> AAZELTON AVENUE <br /> .:KTON, CA 95205 <br /> ,lone: (209)468-3420 <br /> INVOICE AccounllD ARoo40729 <br /> Facility ID FA0022309 <br /> Date Printed 4/30/2014 <br /> SANTIAGO,JORGE RE : TOYO OF STOCKTON <br /> TOYO OF STOCKTON 4113 N WEST LN A <br /> 4444 FEATHER RIVER DR STOCKTON, CA 95204 <br /> STOCKTON, CA 95219 <br /> OWNER : SANTIAGO,JORGE <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0252125---Dateoflnvoice: 4/30/2014 IIIIIIIIiIIIIIIIIIIIIIVIIIVIIVIIIIIIVIIIIIIIIIIIIIIIIIIIIII <br /> 4/30/2014 1920 HMBP-Common Materials—Current year+l year prior $230.00 <br /> 4/30/2014 2220 SM HW GEN<5 TONSNR $213.00 <br /> 4/30/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $35.00 <br /> To for this Invoice $476,00 <br /> Payment Due Date 5/30/2014 <br /> TOTAL DUE this Billing Period $478.00 <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 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> rpt <br />