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JAN JUAWUIN t UUN 1 T <br /> ENVIRONMENTAL HEALTH DEPARTMF Page 1 <br /> 304 E WEBER AVE - 3RD FLOOR <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0026781 <br /> Facility ID FA0015509 <br /> Date Printed 5/25/2005 <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# IN0134335---Date of Invoice: 5/24/2005 11111 1111 111111 11111 IN IIII <br /> Hrs Employee <br /> 4/4/2005 3030 310-FIELD CONSULT 1.20 INFURNA $ 111.60 <br /> �0 Z 7G7 Total for this Invoice $ 111.60 <br /> Payment Due Date 6/24/2005 <br /> TOTAL DUE this Billing Period $ 111.60 <br /> PAYMENT <br /> RECEIVED <br /> JUN 6 2005 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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/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 thereafte <br /> 5255.rpt <br />