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SAN JOAQUIN COUNTY <br /> ENVIF,3fIME','TAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> Account ID AR0023586 <br /> INVOICE <br /> Return This INVOICE with Your PAYMENT Facility ID FA0013954 <br /> Date Printed 10/18/2023 <br /> JASON KHAN RE : WINGSTOP <br /> WINGSTOP 520 CAROLYN WESTON BLVD STE A <br /> 1625 E sSMAVV-AVE-#455-- STOCKTON, CA 95206 <br /> FI ESNti, 0 <br /> OWNER : KHAN,JASON <br /> Date Health <br /> Pfuyj am Description Amount <br /> Invoice# IN0389277---Date of Invoice: 1011812023 11111111 IIIIIi 111lull VIII(IIII(III)(IIII ILII VIII(IIII 11111111111111111111 IN IIII <br /> 10/18/2023 1624 RESTAURANT/BAR 21-50 SEATS PR0518527 $ 355.00 <br /> Total for this Invoice $ 355.00 <br /> /f1/301'2bj3 <br /> TOTAL DUE this Billing Period $ 355.00 <br /> WE MOVED July 17, 2023H <br /> PLEASE CHANGE MAILING ADDRESS ONLY: <br /> WINGSTOP #1028/SPREAD YOUR WINGS <br /> C/O RYAN, SAUNDERS & CO. RA'ME/VT <br /> 155 E. SHAW AVE., STE 108 CF�V�p <br /> FRESNO, CA 93710 OCT 3 0 2023 <br /> SAN JOA QUI <br /> HFgLTyo PgRT 4 7Y <br /> ANT <br /> Please make Checks PAYABLE to: 'END' <br /> or <br /> Pay online at:'htti3s://www.si og v.org/departmentJenvhealthifeeSionIine-fee-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 /> hl End of report <br />