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SAN JOAOUIN COUNTY Page 1 ENVIRONMENTAL HEALTH DEP, MENT 1868 E HAZELTON AVENUE STOCKTON. CA 95205 Phone: (209)468-3420 QUARTERLY Account ID AR0033877 STATEMENT OF EXPENSE Program ID PR0543403 INVOICE Facility ID FA0019036 Billing Period : 4/1/2018-6/30/2018 Date Printed 8/10/2018 ARCHUNDIA,JOAQUIN 3052 E MUNFORD AVE RE: ARCHUNDIA,JOAQUIN B STOCKTON CA 95205 3052 E MUNFORD AVE STOCKTON,CA 95205 Health Date Program Description Hrs Employee Amount Invoice# IN0310116---Date of Invoice: 8/8/2018 I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII 11111 IIII IIII 5/9/2018 S971 OT POSTNG ACTIVITY(Call-Back) $798.00 5/14/2018 SH44 SUBSTANDARD HOUSING-INITIAL CASE PREP $167.20 5/14/2018 SH54 SUBSTANDARD HOUSING-CASE ACTIVITY Office $45.60 5/15/2018 SH44 SUBSTANDARD HOUSING-INITIAL CASE PREP $15.20 Total for this Invoice $1,026.00 Only this amount is subject to appeaP Payment Due Date 9/7/2018 Please make Checks PAYABLE to: EHD / Return a Copy of This STATEMENT with Your PAYMENT *Right to Appeal : You have the right to appeal this Quarterly Statement of Expense by filing a written appeal, along with the $78.00 filing fee,within 30 calendar days of the date the Statement was mailed. Pursuant to San Joaquin County Ordinance Code, Section 8-5401(e), all unpaid costs are processed and placed on the property taxes as a Special Tax Assessment. Note: A Release of Notice of Violation or Release of Lien will be recorded with the San Joaquin County Recorder's Office after all violations are corrected and all costs are paid in full. 0 to 30 days 31 to 60 days 61 to 90 days 91 to 120 days >120 days Account Balance $ 1,026.00 $0.00 $0.00 $0.00 $0.00 $ 1,026.00 5250.rpt