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SAN JOAQUIN COUNTY Page 1 <br /> E=NVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> : TOCKTON, CA 95205 Q <br /> QFC I <br /> INVOICE FpUp)°NME 2Z�12 Account ID AR0026516 <br /> £RM,TjS 9V/CFs Facility ID FA0015391 <br /> Date Printed 11/20/2012 <br /> RAY & BERTHA GARCIA RE : A & R SEPTIC SERVICE <br /> A & R SEPTIC SERVICE 4221 CROWS LANDING RD STE 100 <br /> PO BOX 581170 MODESTO, CA 95351 <br /> MODESTO, CA 95358-0021 <br /> OWNER : GARCIA, RAY & BERTHA <br /> na,P Health <br /> Program - -De�sription 4mn°"tJ <br /> Invoice# IN0233716---Date of Invoice: 11/19/2012 II I I I II V (VIII VIIIV VII VIM VII VIII IN IIIII IIIII WIN <br /> 11/16/2012 4244 PUMPERTRUCK $ 158.00 <br /> Total for this Invoice $ 158.00 <br /> Payment Due Date 12/20/2012 <br /> TOTAL DUE this Billing Period 1 $ 158.00 <br /> Per\ Co v)\lersQ.A-� oN <br /> W� \/\ C11(\r SV% r\e 01" Ia/ l a- <br /> ff ` � PAYMENT <br /> 1�C �ju C1 YU 72YL� T� l S IDA V 6'1 ( , RECEIVED <br /> DEC 12 2012 <br /> Y 5 +k <br /> k\j e o U r N m Pf-r 4rUc k Q.r\ I MO r� <br /> 7—t 0. 12 1 Y\ &v-\ P�CCC 1 cle ri`4 - - —` <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will he added to all Permit Fees For OES/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 thereafter <br /> _`4 rrt <br />