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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 /> Account ID AR0046125 <br /> INVOICE <br /> Facility ID FA0024664 <br /> Date Printed 7/11/2019 <br /> QUINTANA, ROSAURA RE : LA HUACANA ENTERTAINMENT <br /> LA HUACANA ENTERTAINMENT 1005 E PESCADERO AVE STE 221 <br /> 3417 TULLY RD APT 11 TRACY, CA 95304 <br /> MODESTO, CA 95350 <br /> OWNER : QUINTANA, ROSAURA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0320482---Date of Invoice : 3/25/2019 �11]1 11HI 111 11111 1�11 1$1 111 11111 1111 1111 11111 11111 IN IIEI IEI 11111 <br /> 3/25/2019 1621 BAR w/o FOOD PREP $ 270.00 <br /> 6/15/2019 9994 PERMIT FEE PENALTY $ 270.00 <br /> Total for this Invoice $ 540.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 540.00 <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 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />