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San Joaquin County Environmental Health <br />1868 E. Haze1ton Ave. <br />Stockton, CA 95205 <br />209-468-3420 <br />Source: <br />Order Date/Time: <br />Order Number: <br />Operator: <br />Location Code: <br />Web Order (Card Keyed-In) <br />1/7/2023 02:47 PM PST <br />155258229 <br />**********006 <br />Authorization: <br />Agency Amount: <br />Other Agency Amount: <br />Shipping Amount: <br />LN Service Fee: <br />Total Amount(USD): <br />Paid in Full <br />$186.00 <br />$0.00 <br />$0.00 <br />$4.26 <br />$190.26 <br />Payment Information <br />Transaction Type: <br />Card Holder: <br />Payment Method: <br />Approval Code: <br />AVS Response: <br />Purchase <br />Ural Shamsuddin <br />Credit Card (VISA ************9003) <br />01145G <br />Expiration <br />Transaction Ref #: <br />CVV2 Response: <br />Val Code: <br />##/## <br />96700001 <br />Merchant Copy <br />Agency Amount <br />$186.00 <br />Product <br />Annual Permit Fees <br />Product Detail <br />18020 Broadwell St, Lathrop, CA, 95330 <br />IN0374597 <br />AR0050012 <br />Sweet Layers <br />9255229731 <br />San Joaquin County Environmental Health <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />209-468-3420 <br />VitalChek Receipt - Web Order (Card Keyed-In) <br />Cardholder Copy <br />Order Date/Time: 1/7/2023 02:47 PM PST Transaction Type: Purchase <br />Confirmation Number: 155258229 Approval Code: 01145G <br />Payment Applied towards: Annual Permit Fees Transaction Ref #: 96700001 <br />Card Holder: Ural Shamsuddin Payment Method: VI(9003) <br />Bill To <br />Ural Shamsuddin <br />18020 Broadwell St <br />Lathrop, CA 95330 <br />United States of America <br />Authorization: <br />Agency Amount: <br />Other Agency Amount: <br />LN Service Fee: <br />Total Amount(USD): <br />Paid in Full <br />$186.00 <br />$0.00 <br />$4.26 <br />$190.26 <br />Refund Policy: Please contact the agency listed on the receipt to request a <br />refund.