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San Joaquin County Environmei <br />1868 E. Hazelton Ave. <br />Stockton, CA 95205 <br />209-468-3420 <br />Source: POS Order <br />Order Date/Time: 11/12/2021 08:45 AM PST <br />Order Number: 134580967 <br />Operator: MichaelaZ <br />Location Code: **********030 <br />Health <br />Authorization: <br />Paid in Full <br />Agency Amount: <br />$184.00 <br />Other Agency Amount: <br />$0.00 <br />Shipping Amount: <br />$0.00 <br />LN Service Fee: <br />$1.35 <br />Total Amount(USD): <br />$185.35 <br />Payment Information <br />Transaction Type: Purchase Expiration <br />Card Holder: IGNACIO ROJO Transaction Ref #: 207200001 <br />Payment Method: Debit CVV2 Response: <br />Approval Code: 010501 <br />AVS Response: Val Code: <br />Merchant Copy <br />Agency Amount Product Product Detail <br />$184.00 Service Request Or Well Permit 84465 <br />San Joaquin County Environmental Health <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />209-468-3420 <br />VitalChek Receipt - POS Order <br />Cardholder Copy <br />Order Date/Time: 11/12/202108:45 AM PST Transaction Type: Purchase <br />Confirmation Number: 134580967 Approval Code: 010501 <br />Payment Applied towards: Service Request Or Well Permit Transaction Ref #: 207200001 <br />Card Holder: IGNACIO ROJO Payment Method: Debit <br />Bill To <br />IGNACIO ROJO Authorization: <br />Paid in Full <br />Agency Amount: <br />$184.00 <br />Other Agency Amount: <br />$0.00 <br />LN Service Fee: <br />$1.35 <br />Total Amount(USD): <br />$185.35 <br />,-� <br />Refund Policy: Please contact the agency listed on the receipt to request a <br />refund. <br />