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SAN JOAOUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E WEBER AVE-3RD FL OR <br /> STOCKTON. CA 95202 <br /> Phone: 209-468-3420 <br /> INVOICE Account ID <br /> <br /> <br /> RVICE <br /> COUNTRY CL SERVICE 1403 W COUNTRY CLUB BLVD <br /> 1403 W CO Y CLUB BLVD STOCKTON CA 95204 <br /> STOCKTON CA, 95204 <br /> OWNER: CRAIG FURGISON <br /> Health <br /> Date Program Descriptic n Hrs Employee Amount <br /> Invoice# IN0091554---Date of I voice: 1/22/2002 <br /> 1/22/2002 2399 UNIFIED ROGRAM FAC STATE SERVICE FEE $17.50 <br /> 1/22/2002 2220 SM HW G N<5 TONSNF $200.00 <br /> Total for this Invoice $217.50 <br /> Payment Due Date /30 <br /> TOTAL DUE this Billing Period 17.50 <br /> Please make Chec PAYABLE to: EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be addcd to all Permit Fees For all SERVICE FEES <br /> at the Rate of 100° of the Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> PAYMENT <br /> RECEIVED---- -- _ <br /> FED 15 2002 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> E,�VPONMENFAI HEALTH DIVISION <br /> 5255.rpt <br />