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SAN JOAQUIN COUNTY PUB IC H -,TH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH IVl N <br /> 304 E WEBER AVE-3RD FLO R <br /> STOCKTON, <br /> <br /> <br /> <br /> <br /> <br /> COUNTRY CLUB CLEANERS 1901 COUNTRY CLUB BLVD <br /> 1901 COUNTRY CLUB BLVD STOCKTON CA 95204 <br /> STOCKTON CA 95204 OWNER: MICHAEL L DAVIS <br /> Health <br /> Gare I,rogram Description KIS Employee Amount <br /> Invoice# IN0071223---Date of Invoice 4/19/00 <br /> 4/19/2000 2220 SM HW GEN c5 TONSNR $100.00 <br /> 4/19/2000 2399 UNIFIED PRC GRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $110.00 <br /> Payment Due Date 5/2 00 <br /> TOTAL DUE this Billing Period $110.00 <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added 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 /> ap <br /> MAY 22.= <br /> SAN JOAQUIN COLIN 1'Y <br /> PUBLIC HEALTH SERVICES <br /> FNVIRONhFNTR:I_HEALTH MVI.SION <br /> 5255.rpt <br />