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SAN JOAQUIN COUNTY • 4F • Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0000394 <br /> LMOMMOMEMMONES <br /> Facility ID I FA0000395 <br /> J'aN'6 nfwo Mr� Date Printed 1/30/2014 <br /> NP CL `V�, <br /> S-MART#655 RE : SAVE MART #655 <br /> SAVE MART#655 530 W LODI AVE <br /> ° P'q &X Y66N LODI, CA 95240 <br /> MODESTO, CA 95959' <br /> {g352 OWNER : SAVE MART SUPERMARKETS <br /> Dale Program Description Amount <br /> Invoice# IN0246828---Date of Invoice: 1127/2014 / �1p11pp11pp1p111IIEppp11p1111111p11p11p1pp111pp11p11p111p11IN <br /> 1/27/2014 1619 RETAIL MKT>1000 SO FT(=/>2 DEPTS) $ 404.00 <br /> Total for this Invoice $ 404.00 •� <br /> '/ <br /> Payment Due Date 3/1/2014 <br /> Invoice# IN0247002...Date ofInvoice: 1130/2014 11111111111111111111111111111111 <br /> _1/30/2014 _1920 HM_BP-Common Materials $ 145.00 <br /> 1130/2014 2220 SM HW GEN<5 TONSIYR� $ 213.00 <br /> 1/30/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total forthis Invoice $ 393.00 <br /> Payment Due Date 3/1/2014 <br /> TOTAL DUE this Billing Period T <br /> PAYMENT <br /> RECEIVED <br /> FEB 19 2014 <br /> SAN JOAOVIN CCW11 <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 />