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JAN JUAWUIN I;UUN I T <br /> ENVIRONMENTAL HEALTH DEPARTMF KIT <br /> Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 COPY <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0001463 <br /> Facility ID FA0001464 <br /> Date Printed 6/24/2009 <br /> GOGNA,VERNON RE : GOGNA, VERNON 39-176 <br /> GOGNA,VERNON 39-176 13959 E FANNING RD <br /> 13959 E FANNING RD STOCKTON, CA 95215 <br /> STOCKTON, CA 95215 <br /> OWNER : GOGNA, VERNON <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0191504---Date of Invoice: 6/23/2009 I IIIIIII IIIIII III IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIIIII IIIII IIIIIIII <br /> Hrs Employee <br /> 5/21/2009 2745 R27-PREOCCUPANCY RE-INSPECTION 1.00 SOOD $ 105.00 <br /> Total for this Invoice $ 105.00 <br /> Payment Due Date 7/24/2009 <br /> TOTAL DUE this Billing Period $ 105.00 <br /> PAYMENT <br /> RECEIVED <br /> JUL 2 2009 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <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 OES/HMMP 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 />