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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM' ' Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 95202 O V <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0026653 <br /> Facility ID FA0015447 <br /> Date Printed -11/19/2004 <br /> JAMES BYRD/DESIREE BRITT RE : STOCKTON ROYAL THEATRE <br /> STOCKTON WORSHIP CENTER 1825 PACIFIC AVE <br /> 8407 KELLEY DR STOCKTON, CA 95204 <br /> STOCKTON, CA 95209 <br /> OWNER : CORT, DANIEL <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0121670---Date of Invoice: 6/14/2004 I IIIIIII IIIIII III VIII IIIII VIII VIII(IIII IIIII VIII IIIII VIII 111111111111111 IIII <br /> Hrs Employee <br /> 6/3/2004 2950 315-REPORT REVIEW 1.00 LAGORIO $ 93.00 <br /> 6/7/2004 2950 310-FIELD CONSULT 5.10 INFURNA $ 474.30 <br /> 6/7/2004 2950 910-OT FIELD CONSULT 1.50 INFURNA $ 209.25 <br /> 6/8/2004 2950 310-FIELD CONSULT 0.70 INFURNA $ 65.10 <br /> 6/14/2004 9999 PAYMENT ($ 279.00) <br /> 6/25/2004 2950 315-REPORT REVIEW 1.20 INFURNA $ 111.60 <br /> 6/30/2004 2950 315-REPORT REVIEW 1.00 INFURNA $ 93.00 <br /> Total for this Invoice $ 767.25 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 767.25 <br /> � t <br /> PAYMENT' TODAY! <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 OES/HMMP 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 45 Days after the Invoice Date 60 Day, r the Invoice Date and each 30 Days thereafter <br /> 5255.rpt <br />