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SAN JOAQUIN COUNTY <br />fNVOE)NMENTAL HEALTH DEPARTMENT <br />868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />INVOICE <br />BOBOLI INTERNATIONAL LLC <br />6507 PACIFIC AVE #328 <br />STOCKTON, CA 95207-3717 <br />Page 1 <br />Account ID <br />L AR0025031 <br />Facility ID <br />FA0014724 <br />Date Printed <br />1/26/2017 1922 <br />/8/2017 <br />RE: 0 OLI INTERNATIONAL LLC <br />t <br />aX@.CK•Tt� m. � � .. <br />OWNER: BOBOLI INTERNATIONAL INC <br />Date Health <br />Program Description Amount <br />Invoice # IN0288685 --- Date of Invoice : 1/26/2017 <br />1/26/2017 1921 <br />HMBP-Regular-Primary Location <br />$ <br />284.00 <br />1/26/2017 1922 <br />CERS Processing Fee <br />$ <br />25.00 <br />1/26/2017 2399 <br />UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br />$ <br />35.00 <br />Total forthis Invoice <br />$ <br />344.00 <br />Payment Due Date <br />2/25/2017 <br />TOTAL DUE this Billing Period <br />$ <br />344.00 <br />W lqp�l 2-4/1 <br />Doe <br />/ P41-11�151 0 0 <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 />