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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 /> COPY AR0025417 <br /> Account ID <br /> INVOICE <br /> Facility iD FA0014891 <br /> Date Printed 9/27/ <br /> XPRESS AUTO LUBE <br /> XPRESS AUTO LUBE 7730 HOLMAN RD <br /> 7730 HOLMAN RD STOCKTON, CA 95212 <br /> STOCKTON, CA 95212 <br /> OWNER : CHEA, HOEUM <br /> Health <br /> Date Program Description Amount <br /> Invoice# IN0328148---Date of Invoice: 9/26/2019 I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 9/26/2019 1920 HMBP-Common Materials $ 115.00 <br /> 9/26/2019 1922 CERS Processing Fee $ 30.00 <br /> 9/26/2019 2220 SM HW GEN<5 TONSNR $ 249.00 <br /> 9/26/2019 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice $ 443.00 <br /> Payment Due Date 10/27/2019 <br /> TOTAL DUE this Billing Period $ 443.00 <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 />