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SAN JOAQUIN COUNTY Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMO • <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> INVOICE A=unt ID AR0036334 <br /> Facility ID FA0020347 <br /> Data Printed I 1/29/2015 <br /> �r <br /> RE : HD SUPPLY CONSTRUCTION SUPPLY <br /> <br /> <br /> STOCKTON, CA 95205 <br /> OWNER : HD SUPPLY CONSTRUCTION SUPPLY, LTD <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0263164---Date of Invoice: 112912015 IIIIIIIIIIIIIIIVIIIVIIIVIIIVIIIIIIVIIIIIIIIIIIIIIIIIIII VIII IIII IIII <br /> 1/29/2015 1921 HMBP-Regular-Primary Location $ 690.00 <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 $ 938.00 <br /> Payment Due Date 212812015 <br /> TOTAL DUE this Billing Period $ 938.00 <br /> MENTAL HEALTH DEPARTMENT Hasler FIRsr-cuss M"H_ <br /> SAN JOAQUINCOUNTYDIXryh��� V 1uTC1 <br /> 72.+05� `V 0 <br /> 1868 East-HazAve—_ - - ---- _---- h� <br /> . e1[Qn <br /> ZIP 9520 <br /> A11D12602tL3 <br /> `�.or Croom <br /> NIXIE 300 SC 1036 8662/3..5 /2.5 i <br /> RETURN TO SENDER ` - <br /> I 1115H 9CIEl4 ! ADDRESS <br /> }[ (' ENABLE TO FORWARD !� <br /> y <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 />