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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 AR0016729 <br /> INVOICE <br /> Facility ID FA0009729 <br /> Date Printed 11/30/2018 <br /> RYAN COBB RE : CLUTCHES N MORE <br /> CLUTCHES N MORE 3805 WEST LN STE Al <br /> <br /> <br /> /OWNER : RYAN COBB <br /> Date Health <br /> Program Description Amnt nt <br /> i <br /> Invoice# IN0312500---Date of Invoice: 9/26/2018 1111111 hill III IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IN IIIIII 11111 1111 1111 <br /> 9/26/2018 1920 HMBP-Common Materials $ 98.00 <br /> 9/26/2018 1922 CERS Processing Fee $ 30.00 <br /> 9/26/2018 2220 SM HW GEN<5 TONSNR $ 249.00 <br /> 9/26/2018 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice $ 426.00 <br /> Payment Due Date 10/27/2018 <br /> TOTAL DUE this Billing Period $ 426.00 <br /> PAST n U E r <br /> WE WOU YOUR <br /> pA YMENT 7OUAYl <br /> A_�Z T AI I-C A 1 G Is <br /> sj ler- A-t vv�.`u�v <br /> FE'TURIV TO 5EN0ER t <br /> COSS 'RYAN P <br /> 2-6-0aO =TLEFS LN APT '.Ste7 b <br /> LODI CA 95242-9660 <br /> ;1 <br /> RETURN TO SENDER <br /> b1t11111111ib���I MI1% �III\111l+1'Jill 1111,111"111'111.1 H <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 /> j2i4.rpt <br />