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SAN JOAOUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPA. TIENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON. CA 95205 <br /> Phone: (209)468-3420 <br /> QUARTERLY Account ID AR0027044 <br /> STATEMENT OF EXPENSE <br /> Program ID F PR0537938 <br /> INVOICE Facility ID FA0015640j <br /> Billing Period : 10/1/2015-12/3112015 <br /> Date Printed 1/13/2016 <br /> RODRIGUEZ,MAYRA <br /> PO BOX 6734 RE: RODRIGUEZ,MAYRA <br /> STOCKTON CA 95206 2156 S B ST <br /> STOCKTON,CA 95206 <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0273090---Date of Invoice: 1/12/2016 I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII IIIII IIIII VIII IIII IIIIII 111111111 IIII <br /> 11/10/2015 SF54 SUBSTANDARD HOUSING-FIELD ACTIVITY $65.00 <br /> 11/16/2015 SH54 SUBSTANDARD HOUSING-CASE ACTIVITY Office $78.00 <br /> Total for thisInvoicel $143.00 <br /> 4 Only this amount is subject to appeal` <br /> Payment Due Date 1/12/2016 <br /> Please make Checks PAYABLE to: EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> "Right to Appeal : You have the right to appeal this Quarterly Statement of Expense by filing a written appeal, <br /> along with the $78.00 filing fee, within 30 calendar days of the date the Statement was mailed. <br /> Pursuant to San Joaquin County Ordinance Code, Section 8-5401(e), all unpaid costs are processed and <br /> placed on the property taxes as a Special Tax Assessment. <br /> Note: A Release of Notice of Violation or Release of Lien will be recorded with the San Joaquin County <br /> Recorder's Offeue after all violations are corrected and all costs are paid in full. <br /> 0 to 30 days 31 to 60 days61 to 90 days 91 to 120 days >120 days Account Balance <br /> $ 143.00 $0.00 $ 0.00 $ 0.00 $2,30 a's $2,443.44 <br /> 5250.rpt <br />