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Work Order: 2250365 <br /> Official Payments Corp. <br /> Page 1 of 1 <br /> This is a"printer*ienW page.Please use the"print"option in your browser to print this screen. <br /> OFFICIAL <br /> ff PAYMENTS <br /> San Joaquin County -Environmental Health Department, CA <br /> Ertvlronrnental Health Fees <br /> Confirmation Number: A54720 <br /> Payment Date/Time: Monday, April 16, 2007 0 01:11 PM PT <br /> Payer Information <br /> Name: biddy McKenzie <br /> Street Address: 6747 sierra Court <br /> Dublin,CA 94568 <br /> United states <br /> Daytime Phone <br /> Number: (825)551-7555 <br /> E-mail Address: Ikkti@gft.com <br /> Please provide as much kdormetlon as POSSIble below so that we may Iden*your payment: <br /> Address of FacTdy <br /> where work'a being 1234 E Yosemite Avenue.Manteca <br /> done: <br /> Blames$Name: Chevron#209167 <br /> Card Information <br /> Card Type: MasterCard <br /> Card Number: _°"•» .Sm <br /> Expiration Date: 1012009 <br /> Payment Information <br /> Payment Type: Environmental Health Fees <br /> Payment Amount $285.00. <br /> Ccnv*nience Fee: $10.95 <br /> Total Payment: $295.95 fJOIBI = <br /> Copyright 0 2007 Official Payments CwWa8on.All Rights Reserved. <br /> Tanknology Inc. 8501 N.MoPac Expwy#400,Austin,Texas 78759 <br />