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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 /> ount ID AR00305R <br /> INVOICE <br /> Facil' ID FA0017746 <br /> `� <br /> <br /> <br /> KIM ANDERSEN / RE : COOKS COLLISION, AN ABRA CO-TRACY <br /> COOKS CO�USI'ON, AN ABRA CO-TRACY 2830 AUTO PLAZA WAY STE 110 <br /> <br /> <br /> �� OWNER : COOKS COLLISION, AN ABRA CO-TRACY <br /> Date Health <br /> Program Description Amuunt <br /> Invoice# IN0318740---Date of Invoice: 1/22/2019 I(IIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII(IIII IIII IIIIII VIII IIII IIII <br /> 1/22/2019 1921 HMBP-Regular-Primary Location $ 449.00 <br /> 1/22/2019 1922 CERS Processing Fee $ 30.00 <br /> 1/22/2019 2220 SM HW GEN<5 TONSNR $ 249.00 <br /> 1/22/2019 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice $ 777.00 <br /> Payment Due Date 2/27/2019 <br /> TOTAL DUE this Billing Period $ !77.00 <br /> T l 5a� co <br /> PAYMENT MAUly9 <br /> RECEIVED n „^ <br /> MAR 2 5 2019 yAN NJOA UINCOUNTY (' <br /> HKA@0N LMI <br /> 'AN jOAp111,4COUNTY IIEALT II DEPARTM I <br /> ENVIRONME�TMENT <br /> HEALTH DEQ <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 /> 5?�4.rpt <br />