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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Page 1 1868 E HAZELTON AVENUE STOCKTON, CA 95205 Phone: (209)468-3420 Account ID AR0026139 INVOICE Facility ID FA0015214 Date Printed 3/12/2019 OWNER : AMBROSIO, GONZALO Date Health Program Description Amount Invoice# IN0316324---Date of Invoice: 10/30/2018 I IIIIIII IIIIII III VIII VIII VIII VIII VIII IIID VIII VIII VIII VIII I'll IIIIII 11111 IIII IIII 10/30/2018 1634 FOOD VEHICLE/CART(PREPKGD ONLY) $ 107.00 10/30/2018 1634 FOOD VEHICLE/CART(PREPKGD ONLY) $ 107.00 10/30/2018 1634 FOOD VEHICLE/CART(PREPKGD ONLY) $ 107.00 10/30/2018 1634 FOOD VEHICLE/CART(PREPKGD ONLY) $ 107.00 10/30/2018 1634 FOOD VEHICLE/CART(PREPKGD ONLY) $ 107.00 10/30/2018 1634 FOOD VEHICLE/CART(PREPKGD ONLY) $ 107.00 10/30/2018 1634 FOOD VEHICLE/CART(PREPKGD ONLY) $ 107.00 10/30/2018 1634 FOOD VEHICLE/CART(PREPKGD ONLY) $ 107.00 10/30/2018 1634 FOOD VEHICLE/CART(PREPKGD ONLY) $ 107.00 10/30/2018 1634 FOOD VEHICLE/CART(PREPKGD ONLY) $ 107.00 1/15/2019 9994 PERMIT FEE PENALTY $ 107.00 1/15/2019 9994 PERMIT FEE PENALTY $ 107.00 1/15/2019 9994 PERMIT FEE PENALTY $ 107.00 1/15/2019 9994 PERMIT FEE PENALTY $ 107.00 1/15/2019 9994 PERMIT FEE PENALTY $ 107.00 1/15/2019 9994 PERMIT FEE PENALTY $ 107.00 1/15/2019 9994 PERMIT FEE PENALTY $ 107.00 1/15/2019 9994 PERMIT FEE PENALTY $ 107.00 1/15/2019 9994 PERMIT FEE PENALTY $ 107.00 1/15/2019 9994 PERMIT FEE PENALTY $ 107.00 Total for this Invoice $ 2,140.00 PAST DUE TOTAL DUE this Billing Period $ 2,140.00 Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT Penalties will be added to all Permit Fees For HMBP Fees For all SERVICE FEES 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% 30 Days after the Due Date 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter 5254.rpt