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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: 1/7/2023 02:47 PM PST Agency Amount: $186.00 <br /> Order Number: 155258229 Other Agency Amount: $0.00 <br /> Operator: Shipping Amount: $0.00 <br /> Location Code: **********006 LN Service Fee: $4.26 <br /> Total Amount(USD): $190.26 <br /> Payment Information <br /> Transaction Type: Purchase Expiration ##/## <br /> Card Holder: Ural Shamsuddin Transaction Ref#: 96700001 <br /> Payment Method: Credit Card(VISA************9003) CVV2 Response: M <br /> Approval Code: 01145G <br /> AVS Response: N Val Code: <br /> Merchant Copy <br /> Agency Amount Product Product Detail <br /> $186.00 Annual Permit Fees 18020 Broadwell St,Lathrop,CA,95330 <br /> IN0374597 <br /> AR0050012 <br /> Sweet Layers <br /> 9255229731 <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: 1/7/2023 02:47 PM PST Transaction Type: Purchase <br /> Confirmation Number: 155258229 Approval Code: 01145G <br /> Payment Applied towards: Annual Permit Fees Transaction Ref#: 96700001 <br /> Card Holder: Ural Shamsuddin Payment Method: VI(9003) <br /> Bill To <br /> Ural Shamsuddin Authorization: Paid in Full <br /> 18020 Broadwell St Agency Amount: $186.00 <br /> Other Agency Amount: $0.00 <br /> Lathrop, CA 95330 LN Service Fee: $4.26 <br /> United States of America Total Amount(USD): $190.26 <br /> Refund Policy:Please contact the agency listed on the receipt to request a <br /> refund. <br />