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1-.-1 Y <br /> . AL HEALTH DEPARTMENT Page 1 <br /> AZELTON AVENUE ' <br /> rOCKTON, CA 95205 <br /> " Phone: (209) 468-3420 <br /> INVOICE Account ID AR0027285 <br /> Facility ID FA0015753 <br /> Date Printed 10/31/2019 <br /> PAUL BLANCO AUTO PLEX OF STOCKTON RE : PAUL BLANCOS AUTO PLEX OF STOCKTON <br /> SUSAN DEMMING 3190 AUTO CENTER CIR <br /> 2200 FULTON AVE STOCKTON, CA 95212 <br /> SACRAMENTO, CA 95825 <br /> OWNER : PAUL BLANCOS GOOD CAR COMPANY STOI <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0328264---Date of Invoice: 9/26/2019 I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII 11111 <br /> IIII IIII <br /> 9/26/2019 1921 HMBP-Regular-Primary Location $ 398.00 <br /> 9/26/2019 1922 CERS Processing Fee $ 30.00 <br /> 9/26/2019 2226 GEN 5<13 TONS PERMIT <br /> $ 1,949.00 <br /> 9/26/2019 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice $ 2,426.00 <br /> Payment Due Date 10/27/2019 <br /> TOTAL DUE this Billing Period $ 2,426.00 <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 /> 5254.rpt <br />