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ry <br /> 4/29/2014. Official Payments-PayTa)es,Utility Bills,Tuition&Jo line <br /> This is a"printer friendly'page. Please use the"print"option in your browser to print this screen. <br /> l' <br /> �i Ft1iiL <br /> PAYMEIIN <br /> .K San Joaquin County -Environmental Health Department, CA <br /> Environmental Health Fees <br /> Confirmation Number: 019295 <br /> Payment Date: Tuesday,April 29,2014 <br /> Payment Time: 08:59AM PT <br /> Payer Information <br /> Name: Anthony Smith <br /> Street Address: 1111 Broadway <br /> 6th Floor <br /> Oakland,CA 94606 <br /> United States <br /> Daytime Phone (510)285-2770 <br /> Number: <br /> E-mail Address: tsmith@geosyntec.com <br /> Please provide as much information as possible below so that we may identify your payment: <br /> Address ofFacility <br /> where work is being W Church Stand S San Jose St Stockton <br /> done: <br /> Buisness Name: across stfrom Newark Recycled Fibers <br /> i <br /> i <br /> Card Information <br /> Card Type: <br /> Card Number: <br /> Expiration Date: <br /> i <br /> Payment Information <br /> Payment Type: Environmental Health Fees <br /> Payment Amount: $500.00 <br /> I <br /> Convenience Fee: $10.95 <br /> Total Payment: $510.95 <br /> Thank you for using Official Payments.If you have a question regarding your payment,please callus toll free at <br /> 1-800-487-4567.To make payments in the future,please visit ourwebsite atwww.officialpayrnents.com. <br /> Copyright©2014 Official Payments Corporation.All Rights Reserved. <br /> Official Payments Corporation is a licensed money transmitter in 44 states,the District of Columbia,and Puerto Rico.Official <br /> Payments is not required to be licensed as a money transmitter in Indiana, Massachusetts, Montana, New Mexico,South <br /> Carolina or Wisconsin. <br /> i <br />' I <br /> i <br /> iI <br /> I htt /AA wr.official a nts.conV c_ste rint.'s JSESSIONID=Sr4mTfLBT8JrJST.1284111692!-1315623437 1/1 <br /> ps: p yme P P6J� 1 p� � <br />