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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 AR0030141 <br /> INVOICE <br /> Facility ID FA0017259 <br /> Date Printed 9/27/2018 <br /> MOTOIKE FARM RE : MOTOIKE FARM <br /> 1700 N JACK TONE RD 1700 N JACK TONE RD <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 <br /> OWNER : MOTOIKE FARM <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0315067---Date of Invoice: 9/26/2018 11111 1111 111111 IEI 1111 1111 <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 $ 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 /> PAYMENT <br /> RECEIVED <br /> N 6 a-;, OCT 12 2018 <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 /> i'_54.rpt <br />