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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 /> �/ <br /> Account ID <br /> AR0016729 <br /> INVOICE <br /> Facility ID FA0009729 <br /> Date Printed 4/10/2015 <br /> RYAN COBB RE : CLUTCHES N MORE <br /> CLUTCHES N MORE 3805 N WEST LN STE Al <br /> 3805 WEST LN STE Al STOCKTON, CA 95204 <br /> STOCKTON, CA 95204 <br /> OWNER : RYAN COBB <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0265305---Date of Invoice: 4/1012015 IIIi�I�III�II III VIII VIII VIII VIII(IIII VIII(IIII(IIII VIII IIII IIIIII 11111 1111 IN <br /> 4/10/2015 1920 HMBP-Common Materials $ 85.00 <br /> 4/1012015 2220 SM HW GEN<5 TONS/YR $ 213.00 <br /> 4/10/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> 4/15/2015 9996 APPLY DISCOUNT ($ 53 25) <br /> Total for this Invoice $ 279.75 <br /> Payment Due Date 511 012 01 5 <br /> TOTAL DUE this Billing Periodl $ 279.75 <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 /> Z J rpt <br />