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SAN JOAQUIN COUNTY �/ Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE Accountl0 AR0026737 <br /> Facility ID FA00 55495 <br /> LUMMEMMUMMONA <br /> Date Printed 2/28/2013 <br /> STOUT ROOFING OF CALIFORNIA IN RE : STOUT ROOFING OF CALIFORNIA INC <br /> 3480 CARPENTER RD 3480 CARPENTER RD <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 <br /> OWNER : SCOTTDEBROUWER <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0236958---Date of Invoice: 2/1/2013 IIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII 111111111 IIII <br /> 2/1/2013 1921 HMBP-Regular-Primary Location $ 315.00 <br /> 2/1/2013 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Totalfor this Invoice I $ 350.00 <br /> Payment Due Date 3/3/2013 <br /> TOTAL DUE this Billing Period $ 350.00 <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 />