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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT r- Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> Account ID AR0029764 <br /> INVOICE <br /> Facility ID FA0016882 <br /> Date Printed 10/31/2017 <br /> D A COSTA FARMS RE : DA COSTA FARMS <br /> PO BOX 185 15805 E HWY 120 <br /> ESCALON, CA 95320 RIPON, CA 95366 <br /> OWNER : DA COSTA FARMS <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0289068---Date of Invoice: 1/26/2017 ( IIIIII II I I VI I VII V II VI V I V I VII V I II I I I I VIII IIII IIII <br /> 1/26/2017 1922 CERS Processing Fee I�j $ 25.00 <br /> 1/26/2017 1958 HM-Farm Operations ,, ` �,�-� ` $ 20. <br /> 1/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEES/\ $ .00 <br /> �W \J Total for this Invoice $ 80.00 <br /> PAST DU <br /> Invoice# IN0299289---Date of Invoice: 912612017 1111111 IIIIII III VIII VIII IIIII(IIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 9/26/2017 1922 CERS Processing Fee $ 25.00 <br /> 9/26/2017 1958 HM-Farm Operations �' ` J $ 22 <br /> 9/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ .00 <br /> Total for this Invoice $ 96.00 <br /> Payment Due Date 10/29/2017 <br /> TOTAL DUE this Billing Period $ 176.00 <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 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />