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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E HAZELTON AVENUE STOCKTON, CA 95205 Phone: (209) 468-3420 INVOICE IAN KOETSIER 21447 S MANTECA RD MANTECA, CA 95337 Page 1 Account to AR0029646 Facility ID I FA0016764 Date Pnnted 1/29/2015loommoommommmme RE : IAN KOETSIER 21447 S MANTECA RD MANTECA, CA 95337 Total for this Invoice $ 107.00 Payment Due Date 2/2812015 TOTAL DUE this Billing Period $ 107.00 0 D FEB 1 x,,2615 ENVIRONM SN�ViCES N PERM Please make Checks PAYABLE to: 'EHD' - Return a Copy of This STATEMENT with Your PAYMENT Penalties will be added to all Permit Fees For HMBP Fees OWNER: IAN KOETSIER 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% 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter Date Health _ - Program Description Am 1. I Invoice# IN0262200 -- Date of Invoice: 1/29/2015 11111111 HIM 1111111111111111111111111111111111111111111111111111111111111111111 IN 1/29/2015 1958 HM -Farm Operations $ 18.00 1/29/2015 2221 USED OIL ONLY - <5 TONS/YR $ 54.00 1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 Total for this Invoice $ 107.00 Payment Due Date 2/2812015 TOTAL DUE this Billing Period $ 107.00 0 D FEB 1 x,,2615 ENVIRONM SN�ViCES N PERM Please make Checks PAYABLE to: 'EHD' - Return a Copy of This STATEMENT with Your PAYMENT Penalties will be added to all Permit Fees For HMBP Fees For all SERVICE FEES 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% 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter