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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />Page 1 <br />Account ID AR0052698 <br />INVOICE <br />Return This INVOICE with Your PAYMENT Facility ID FA0027360 <br />Date Printed F 9/30/2022 <br />loommoommomomma <br />LICENSING RE: SAFEWAY FUEL #5816 <br />SAFEWAY FUEL #5816 19533 S MOUNTAIN HOUSE PKWY <br />PO BOX 29096 MS #6516 MOUNTAIN HOUSE, CA 95391 <br />PHOENIX, AZ 85038 <br />OWNER: SAFEWAY INC <br />Date Health <br />Program Description Amount <br />Invoice # IN0374398 --- Date of Invoice : 9/30/2022 <br />9/30/2022 1617 RETAIL MARKET> 1000 SQ FT W / FOOD PREP <br />I IIIIIIIIIIIII III VIII VIII IIIIIIIIII IIID VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br />PRO547980 $ 301.00 <br />Total for this Invoice $ 301.00 <br />TOTAL DUE this Billing Period $ 301.00 <br />V" Would you like Invoices electronically or need to update the email address for this account? Fill out the <br />form below with the information with up to 2 email addresses: <br />Email 1 <br />Email 2 <br />Please make Checks PAYABLE to: 'EHD' or <br />Pay online at: 'hftt)s://www.sioov.orcildepartmentlenvhealttVfees/online-fee-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 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br />5254.rpt End of report <br />