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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> AMEN E <br /> Account ID AR0035495 <br /> EiNvoicE <br /> Facility ID FA0019916 <br /> Date Printed7/28/2016 <br /> RE : ALFALFA SUPPLY INC <br /> ALFALFA SUPPLY <br /> <br /> <br /> OWNER : ALFALFA SUPPLY INC <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0276748---Date ofinvoice: 2/2/2016 Iilllllllllllilllllllillllllllllllllllllillllllllllllllllilllllillllillllllllllllllll <br /> 2/2/2016 1920 HMBP-Common Materials <br /> 2/2/2016 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 85.00 <br /> 2/12/2016 9999 PAYMENT $ 35.00 <br /> 7/15/2016 9997 CORRECTION TO A CHARGE ($ 120.00) <br /> 7/28/2016 1921 HMBP-Regular-Primary Location ($ 85.00) <br /> $ 315.00 <br /> Total for this Invoice $ 230.00 <br /> PAST DUE <br /> TOTAL DUE this Bi!liog Perk,j $ 230.00 <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 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 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />