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BILLING_2020
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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KETTLEMAN
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2347
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1600 - Food Program
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PR0505996
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BILLING_2020
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Entry Properties
Last modified
9/16/2020 5:04:39 PM
Creation date
9/16/2020 4:59:05 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
BILLING
FileName_PostFix
2020
RECORD_ID
PR0505996
PE
1626
FACILITY_ID
FA0007134
FACILITY_NAME
BLACK BEAR DINER - LODI
STREET_NUMBER
2347
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95242
CURRENT_STATUS
01
SITE_LOCATION
2347 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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S,AN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> COPY Account ID AR0010334 <br /> <br /> <br /> <br /> <br /> <br /> 95242 <br /> 4320= <br /> ,365 511-1 C-7. OWNER : CALIFORNIA RESTAURANT CONCEPTS INC <br /> 06"IGtp, r'R.qtj <br /> Date Health <br /> D.v..,.CM Description AffWunt <br /> Invoice# IN0339125---Date of Invoice: 7/29/2020 111111 h 11111 11111 11111 11111 11111 111 1111�11111 11111 El 111111 1111�IV IN <br /> 7/29/2020 1626 RESTAURANT/BAR 101 +SEATS $ 42_�90 <br /> Total for this Invoice I $ 425.00 <br /> Payment Due Date 8/30/2020 <br /> TOTAL DUE this Billing Period $ 425.00 <br /> PAYMENT <br /> RECEIVED <br /> AUG 2 8 2020 <br /> SAN°IRAQUIN <br /> HEALTH DEPARTMENT <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 />
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