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SAN JOACUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0005527 <br /> Facility ID FA0005082 <br /> Date Printed 1/30/2014 <br /> loomommommommom <br /> COOPER OUT WEST RE : COOPER OUT WEST <br /> 18636 E MILTON RD 29756 E ORANGE AVE <br /> LINDEN, CA 95236 ESCALON, CA 95320 <br /> OWNER: COOPER OUT WEST <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0247654—Date of Invoice: 1/30/2014 ill ll l ll l 111 l lA VIII VII V I VIII IIII V II III I I VIII IIII IIII <br /> 1/30/2014 1958 HM-Farm Operations $ 18.00 <br /> 1/30/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for Nis Invoice $ 53.00 <br /> Payment Due Date 3/1/2014 <br /> TOTAL DUE this Billing Period $ 53.00 <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 />