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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPART' 'T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> 1 NVOICE Account ID AR0026781 <br /> C (DFIY Facility ID FA0015509 <br /> Date Printed 6/14/2006 <br /> owe <br /> ST FRANCIS MOTEL RE : ST FRANCIS MOTEL <br /> 5708 N HWY 99 5708 N HWY 99 <br /> STOCKTON, CA 95212 STOCKTON, CA 95212 <br /> OWNER : PATEL, GIRISHKUMAR K <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0149349---Date of Invoice: 5/19/2006 I IIIIIII IIIIII III VIII VIII IIIII IIIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> Hrs Employee <br /> 4/3/2006 3030 315- REPORT REVIEW 0.60 INFURNA $ 55.80 <br /> 4/12/2006 3030 315-REPORT REVIEW 0.70 INFURNA $ 65.10 <br /> 4/14/2006 3030 310-FIELD CONSULT 1.40 INFURNA $ 130.20 <br /> 4/20/2006 3030 310-FIELD CONSULT 1.10 INFURNA $ 102.30 <br /> 4/27/2006 3030 312-CONSULTATION 1.00 INFURNA $ 93.00 <br /> 4/28/2006 3030 310-FIELD CONSULT 0.90 INFURNA $ 83.70 <br /> Total for this Invoice $ 530.10 <br /> Payment Due Date 6/22/2006 <br /> Invoice# IN0149782---Date of Invoice: 6/13/2006 11111111 IIIIII III IIT IIIII IIIII IIIII IIID IIIII IIIII IIIII 111111111111111111111111 IIII <br /> Hrs Employee <br /> 5/2/2006 3030 310-FIELD CONSULT 1.80 INFURNA $ 167.40 <br /> 5/3/2006 3030 310- FIELD CONSULT 3.00 INFURNA $ 279.00 <br /> 5/4/2006 3030 315- REPORT REVIEW 1.20 INFURNA $ 111.60 <br /> 6/12/2006 3030 315- REPORT REVIEW 3.00 INFURNA $ 279.00 <br /> Total forthis Invoice $ 837.00 <br /> Payment Due Date 7/13/2006 <br /> TOTAL DUE this Billing Period $ 1,367.10 <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 DES I HMMP 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 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />