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SAN JOAQUIN COUNTY <br /> Page 1 <br /> / <br /> ENVIRONMENTAL HEALTH DEPART�JTj {� f� <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 4 s — <br /> Phone: (209) 468-3420 <br /> Account ID AR0016729 <br /> INVOICE <br /> Facility ID F FA0009729 <br /> LEMEMEMENNIONMEN <br /> Date Printed 4/10/2015 <br /> RYAN COBB RE : CLUTCHES N MORE <br /> CLUTCHES N MORE 3805 N WEST LN STE Al <br /> 3805 WEST LN STE Al STOCKTON, CA 95204 <br /> STOCKTON, CA 95204 <br /> OWNER : RYAN COBB <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0265305---Date of Invoice: 4/10/2015 11111ITI1111111111INI1111111111111111111111111111111111IEIN <br /> 4/10/2015 1921 HMBP-Regular-Primary Location $ 255.00 <br /> 4/10/2015 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 4/10/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice I $ 503.00 <br /> Payment Due Date 5/10/2015 <br /> TOTAL DUE this Billing Period $ 503.00 <br /> �l <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 /> i'S4 rpt <br />