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SAN JOA'QUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> Account ID AR0008426 <br /> INVOICE <br /> Facility ID FA0006439 <br /> Date Printed 2/26/2020 <br /> COUNTRY CLUB MOBIL CIRCLE K RE : COUNTRY CLUB MOBIL CIRCLE K <br /> CALIFORNIA FUEL SUPPLY 2575 COUNTRY CLUB BLVD <br /> 587 YGNACIO VALLEY ROAD STOCKTON, CA 95204 <br /> WALNUT CREEK, CA 94596 <br /> OWNER : CALIFORNIA FUEL SUPPLY <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0334524---Date of Invoice: 2/25/2020 IIIIII IIIIII III VIII VIII IIIII IIIII VIII VIII VIII VIII VIII IIII IIIIII 111 <br /> IIII IIII <br /> Hrs Employee <br /> 1/30/2020 2351 333-INSPECTION/REINSPECTION(Chargeable) 1.70 RIVERA S 258.40 <br /> Total for this Invoice $ 258.40 <br /> Payment Due Date 3/27/2020 <br /> TOTAL DUE this Billing Period $ 258.40 <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 /> i254.rrt <br />