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sAN JUAQUIN COUNTY ' <br /> ENVIRONMENTAL HEALTH DEPARTIl 'T Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 9 <br /> <br /> <br /> INVOICE <br /> Facility ID FA0023993 <br /> Date Printed 6/6/2017 <br /> DUBOIS, BEAU RE : NOR CAL ISLAND HOT DOGS#4PU6672 <br /> NOR CAL ISLAND HOT DOGS#4PU6672 8095 RIO BLANCO RD <br /> 4900 N HWY 99#112 STOCKTON, CA 95219 <br /> STOCKTON,CA 95212 <br /> OWNER : DUBOIS, BEAU <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0292588—Date of Invoice: 5/2/2017 I IIIIIII IIIIII IIIIIIIIIIIII IIIIIIIIIIIIIII IIIIIIIIII(IIIIIIIIIIIII IIIIII IIIIIIIIIIIII <br /> Hrs Employee <br /> 4/26/2017 1602 061 -CONSULTATION 1.00 PEDRAZA $ 139.00 <br /> 5/2/2017 9999 PAYMENT ($ 139.00) <br /> 5/15/2017 9998 CORRECTION TO A PAYMENT $ 139.00 <br /> 5/16/2017 9003 RETURN CHECK FEE $ 28.00 <br /> Total forthis Invoice $ 167.00 <br /> Payment Due Date 6/15/2017 <br /> Invoice# IN0292669—Date of Invoice: 5/412017 IIIIIII IIIIIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIIIIIIII IIII IIIIIIIIIIIIIIIIIII <br /> 5/4/2017 1633 FOOD VEHICLE/CART(LTD FOOD PREP) $ 154.00 <br /> 5/4/2017 9999 PAYMENT ($ 154.00) <br /> 5/15/2017 9998 CORRECTION TO A PAYMENT $ 154.00 <br /> 5/16/2017 9003 RETURN CHECK FEE $ 28.00 <br /> 6/6/2017 9003 RETURN CHECK FEE $ 5.75 <br /> Total for ihls Invoice $ 187.75 <br /> Payment Due Date 6/15/2017 <br /> TOTAL DUE this Billing Period $ 354.75 <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 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />