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SAN JOAQUIN COUNTY <br />ENV,'RONWENTAL HEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />INVOICE <br />L%/e.yv/ �� 3 <br />NC <br />—2966VTGN--.,CA <br />R—CN <br />-- -ST 9rrYtS- <br />Page 1 <br />\cw Account ID AR0029948 <br />Facility ID FA0017066 <br />Date Printed 9/27/2018 <br />1980 WHITE LN <br />STOCKTON, CA 95215 <br />OWNER: AAD4ZAUCM <br />Date Health <br />Program Description Amount <br />Invoice # IN0314888 --- Date of Invoice : 9/26/2018 <br />9/26/2018 1922 CERS Processing Fee <br />9/26/2018 1958 HM -Farm Operations <br />9/26/2018 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />&Ojljjd4� <br />/00 <br />l9 GJ�u�.e� lam, <br />$ 30.00 <br />$ 22.00 <br />$ 49.00 <br />Total for this Invoice 1 $ 101.00 <br />Payment Due Date 10/27/201118 <br />TOTAL DUE this Billing Period $ 101.00 <br />PAYMIENT <br />RECE►VED <br />OCT 17 2018 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />kftDRE--�S F� hu- <br />l�1�-/IV€ <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 (Gays after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br />5254.rpt <br />