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f' ti <br /> SAN JOAQUIN COUNTY <br /> Page 1 <br /> EI�VIRONn�ENTAL HEALTH DEPARTMF�`'T <br /> 600t'NIAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0001409 <br /> Facility ID FA0001410 <br /> { Date Printed 9/15/2008 <br /> I- <br /> KHANSHALI, YASIR RE . SAM'S MARKET& PRODUCE <br /> SAM'S MARKET& PRODUCE 9542 S AIRPORT WAY <br /> 9542 S AIRPORT WY MANTECA, CA 95336 <br /> MANTECA, CA 95336 <br /> OWNER ., KHANSHALI, YASIR <br /> { <br /> ' Date Health <br /> Program Description Amount <br /> Invoice# IN0176237---Date of Invoice: 5/27/2008 Illlfllf IfllfIllllllfllllllllllllllIllilllllllllflllllllllllllfllllllllllllflllllllfllllll <br /> 5/27/2008 1615 RETAIL MKT<2000 SQ FT (PREPKGD 1 LTD PREP) $ 175.00 <br /> ' 5/27/2008 4242 WASTE WATER TX PLANT $ 470.00 <br /> 8/15/2008 9994 PERMIT FEE PENALTY $ 175.00 <br /> 8115112008 9994 PERMIT FEE PENALTY $ 470.00 <br /> Total for this Invoicel $ 1,290.00 <br /> PAST DUE <br /> , <br /> TOTAL DUE this Billing Period $ 1 290.00 <br /> 1 <br /> 4 <br /> 1 <br /> PAYMENT <br /> RECENED <br /> i <br /> SEP 1 7.2008 <br /> SAN J0AQ1jIN Cout+l'TY. <br /> i FNVIRONMENTA- <br /> HEALTH DEQARTMENT <br /> y <br /> Please make Checks PAYABLE to: 'EHD' Return a Copy of This STATEMENT with Your PAYMENT <br /> i <br /> Penalties will be added to all Permit Fees For OES I HMMP Fees For all SERVICE FEES <br /> I— 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 46 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />