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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> COPY <br /> 'NVO'C Account ID AR0002858 <br /> IIIJ <br /> Facility ID FA0003284 <br /> Date Printed 10/24/2016 <br /> LAL, JOGINDER RE : FOOD MART GASOLINE* <br /> JOGINDER LAL 2185 E FREMONT ST <br /> 125 EAST WINNEMUCCA BLVD. STOCKTON, CA 95205 <br /> WINNEMUCCA, NV 89445 <br /> M�`s <br /> WNER : LAL, JOGINDER )Q� <br /> em V vS er7_0_ Cb <br /> Date Health <br /> Amount <br /> Program Description <br /> Invoice# IN0282890--Date of Invoice: 9/21/2016 1111111 IIIIII III IIIII IIIII IIIII IIIII IIIA VIII IIIIIIIIII IIII IIIIII VIII IIII IIII <br /> Hrs Employee <br /> 8/¢/2016 2220 306-FOLLOW UP FOR NON-COMPLIANCE 0.3 RIVERA $ 41.70 <br /> M3/2016 2220 306-FOLLOW UP FOR NON-COMPLIANCE 0. 0 RIVERA $ 41.70 <br /> Q(Zdsa"� aSS Totalforthielnvoice $ 63.40 <br /> Payment Due Date 10/22/2016 <br /> t^C vN�^d TOTAL DUE this Billing Period $ 83.40 <br /> T ST. <br /> � ) 7LO 2I rS- - FS K <br /> f� 0j C174- 9 <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 /> iJS4 mt <br />