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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE ' <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> Account ID AR0030325 <br /> INVOICE <br /> Facility ID FA0017443 <br /> Date Printed 9/27/2018 <br /> JOHN T PETERSEN RE : JOHN T PETERSEN <br /> 3838 KINGDON RDS 3838 KINGDON RD <br /> LODI, CA 95242 LODI, CA 95242 <br /> OWNER : JOHN T PETERSEN <br /> Date Health <br /> Pronrpm Description Amount <br /> Invoice# IN0315258---Date of Invoice: 9/26/2018 �11111 11111 H 11111�H�111�11111 111 Hil 111 11H 1111111 11111�1111�IE IN <br /> 9/26/2018 1922 CERS Processing Fee $ 30.00 <br /> 9/26/2018 1958 HM-Farm Operations $ 22.00 <br /> 9/26/2018 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE S 49.00 <br /> Total for this Invoice $ 101.00 <br /> Payment Due Date 10/27/2018 <br /> TOTAL DUE this Billing Period $ 101.00 <br /> �1� r 1 <br /> Y � <br /> OCT , 0 2010 <br /> 'ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <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 />