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OUNTY <br /> o Page 1 <br /> � 14TAL HEALTH DEPARTMENT <br /> LELTON AVENUE <br /> (ON, CA 95205 <br /> te: (209) 468-3420 <br /> Account ID F AR0005843 <br /> INVOICE <br /> Facility ID F FA0005381 <br /> Date Printed F 3/4/2015 <br /> LMEMENNOWNWOMEMS <br /> J LOMBARDI FARMS RE : J LOMBARDI FARMS <br /> 16998 E GAWNE RD 29665 KASSON RD <br /> STOCKTON, CA 95215 TRACY, CA 95376 <br /> OWNER : J LOMBARDI FARMS <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0260548--Date of Invoice: 112912015 llllllllllll VIIVIIIVIIVIIIVIVIIIVIIIVIIIVIIIIIiIIIIII 111111111 IN <br /> 1/29/2015 1958 HM-Farm Operations $ 18.00 <br /> 1/29/2015 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total for this Invoice $ 266.00 <br /> ❑ D Payment Due Date 2/28/2015 <br /> Invoice# IN0263714---Date of Invoice: 21512015 MAR 16 2015 I1111111IIIIIIIIIVIII(IIIIVIIIIIIIIIIIIIVIIIIIIII111111111111111111111111IN <br /> 2/5/2015 APSA APSA SURCHARGE ECi�IRQ7P16V4EN7 V Cfl�H $ 26.00 <br /> Total for this Invoice $ 26.00 <br /> Payment Due Date 3/6/2015 <br /> ttf,h�7 fi I 'x �f . TOTAL DUE this Billing Period $ 292.00 <br /> 61(Tytgx-t ' <br /> �L.UL7t-- <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 1000/6 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 />