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SA" i JOAQUIN COUNTY PUBLIC HF '*,TH SERVICES Page 1 <br /> ENVIRONMENTAL HEALTH DMS <br /> 304 E WEBER AVE-3RD FLOOR <br /> STOCKTON, CA 95202 <br /> 209-468-3420 <br /> INV <br /> LMOMOMMMMMMA <br /> Facility ID FA0009885 <br /> LZENEEMENEWEIMMI <br /> Date Printed 4/25/00 <br /> COUNTRY NISSAN RE: COUNTRY NISSAN <br /> C/O CAROL BREWER 1515 N MAIN ST <br /> 1515 N MAIN ST MANTECA CA 95336 <br /> MANTECA CA 95336 OWNER: VINTAGE INVESTMENTS <br /> Health <br /> Date Program Description Hrs Employee Amount <br /> Invoice# IN0070443—Date of Invoice: 4119100 <br /> 4/19/2000 2220 SM HW GEN<5 TONSNR $100.00 <br /> 4/19/2000 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE $10.00 <br /> Total for this Invoice $110.00 <br /> Payment Due Date 5/25 00 <br /> TOTAL DUE this Billing Period $110.00 <br /> Please make Checks PAYABLE to: PHS/EHD / Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For all SERVICE FEES <br /> at the Rate of 100%ofthe Base Fee Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 60 Days after the Invoice Date and each 30 thereafter <br /> SAPl JbpOU1N OC.,.Jmh r.; <br /> PUBLIC-1c��•�� "" <br /> 5255.rpt <br />