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04-02-' 13 14:28 FROM- N9rFoods 6elTaco 209-521-B561 . T-092 P0003/0003 F-137 <br /> SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKPhone: ON,209 46 95205 �O�! <br /> Phone: (2D9)468-3420 Y <br /> Account It) WQ030919 <br /> INVOIC <br /> Facility to FA0017728 <br /> Date Printed 312 812 01 3 <br /> ROBERTO MARTINEZ RE: DEL TACO <br /> 10506 TRINITY PKWY <br /> DEL TACO STOCKTON,CA 95219 <br /> 3421 TULLY RD STE G1 <br /> MODESTO,CA 95350 OWNER: MARTINEZ,ROBERTO <br /> Health Amount <br /> Date Program Description <br /> invoice# IN0237780.--Dateof Invoice: 21112013 III'll'I'III�IIII'�II�iIIIIIII�II�IIIf�llll�II�IIIII�III��IIIIII�IVIIII��IIIIIiII <br /> $ 255.00 <br /> 211/2013 1921 HMBP-Regular-Primary Location $ 35.00 <br /> 211/2013 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE <br /> Total fol this lnvolca $ 290.00 <br /> Payment Due Date 31312013 <br /> PQ 1' Dun",".V TOTAL DUE this Billing Period $ 290.00 <br /> P :, <br /> WE WOULD APPAECIAfE YOUR <br /> PAYMENT TODAY] <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> For all SERVICE FEES <br /> Penalties will be added to al!Permit Pees For HMBP Fees penalties will be added at the Rate of 10% <br /> of the Rate of 700%of the Baso Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 45 Days after the lnvolca Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />