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San Joaquin County Environmental Health <br /> 1868 E.Hazelton Ave. <br /> Stockton,CA 95205 <br /> 209-468-3420 <br /> Source: Web Order(Card Keyed-In) Authorization: Paid in Full <br /> Order Date/Time: 8/13/2019 04:18 PM PDT Agency Amount: $1368.00 <br /> Order Number: 94988499 Other Agency Amount: $0.00 <br /> Operator: Shipping Amount: $0.00 <br /> Location Code: *4:4:4: 4:****006 LN Service Fee: $31.33 <br /> Total Amount(USD): $1399.33 <br /> Payment Information <br /> Transaction Type: Purchase Expiration ##/## <br /> Card Holder: Laura McCulloch Transaction Ref#: 523300001 <br /> Payment Method: Credit Card(AMEX************1006) CVV2 Response: <br /> Approval Code: 168248 Auth Txn Id#: <br /> AVS Response: Y Val Code: <br /> 'k I/0M g h A±4rcn-ti 11 SerchnntrCCopy <br /> Agency Amount Product l%O Product Detail <br /> $456.00 Service Request Or Well Permit 23505 N.Lamb Road <br /> Hultgren-Tillis Engineers <br /> 9256856300 <br /> $456.00 Service Request Or Well Permit 13590 W.Walnut Grove Road <br /> Hultgren-Tillis Engineers <br /> 9256856300 <br /> $456.00 Service Request Or Well Permit 13022 W.Walnut Grove Road <br /> Hultgren-Tillis Engineers <br /> 9256856300 <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> San Joaquin County Environmental Health <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 <br /> 209-468-3420 <br /> VitalChek Receipt-Web Order(Card Keyed-In) <br /> Cardholder Copy <br /> Order Date/Time: 8/13/2019 04:18 PM PDT Transaction Type: Purchase <br /> Confirmation Number: 94988499 Approval Code: 168248 <br /> Payment Applied towards: Service Request Or Well Permit,Service Request Transaction Ref#: 523300001 <br /> Or Well Permit,... <br /> Card Holder: Laura McCulloch Payment Method: AX(1006) <br /> Bill To <br /> Laura McCulloch Authorization: Paid in Full <br /> 1683 Egret Drive Agency Amount: $1368.00 <br /> Other Agency Amount: $0.00 <br /> Tracy, CA 95376 LN Service Fee: $31.33 <br /> United States of America Total Amount(USD): $1399.33 <br /> Refund Policy:Please contact the agency listed an the receipt to request a <br /> refund. <br />