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COUNTY <br /> ..MENTAL HEALTH DEPARTMENT Page 1 <br /> HAZELTON AVENUE <br /> IOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> Account ID AR0030356 <br /> INVOICE <br /> Return This INVOICE with Your PAYMENT FacilityiD FA0097474 <br /> Date Printed 11/5/2020 <br /> BENTZ FARMS RE: BENTZ FARMS <br /> 17587 N DEVRIES RD <br /> 201 E OAK ST L <br /> LODI,CA 95240 ODE,GA 95242 <br /> OWNER: BENTZ FARMS <br /> Date Health <br /> Program Description Amount <br /> Invoice## IN0346310—Date of Invoice: 111312020 I IIIIII�IIIIII II�IIII VIII i IIIrI II�I I��Il r�lll�l�ll`�IF�III I 1111111111111 <br /> 11/3/2020 1922 CERS Processing Fee l l l I 5[ 30.00 <br /> 11!3!2020 1958 HM-Farm Operations S 22.00 <br /> 11/3/2020 2399 UWIED PROGRAM FAC STATE SURCHARGE FEE S 49.00 <br /> Total for this Invoice $ 101.00 <br /> Payment Due bate 12!512020 <br /> TOTAL DUE this Billing Period $ 101.00 <br /> �7 <br /> 1L Cre �jJ�Je �I� � l liz r �f- <br /> J �1 <br /> 7'T0.G '�-5 <br /> DEC 17 2020 <br /> ana lPrN?I71N cpy�Nr v <br /> M�iu <br /> Please make Checks PAYABLE to: 'EHD' <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 />