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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT RECEIVED FEB -' 5 2021 Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> Account ID I F—A—R0-0-13-2-9-0—i <br /> INVOICE <br /> Return This INVOICE with Your PAYMENT Facility ID FA0007693 <br /> Date Printed 1/29/2021 <br /> <br /> <br /> <br /> <br /> OWNER : BRADLEY ONETO <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0344378---Date of Invoice: 11/3/2020 IIIIIIII III VIIIIIIIIIIIIIIII VIIIA VIIIIIIIII VIII IIII IIII <br /> 11/3/2020 1921 HMBP-Regular-Primary Location $ 483.00 <br /> 11/3/2020 1922 CERS Processing Fee $ 30.00 <br /> 11/3/2020 2220 SM HW GEN<5 TONSNR $ 249.00 <br /> 11/3/2020 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice $ 811.00 <br /> Payment Due Date 12/5/2020 <br /> TOTAL DUE this Billing Period $ 811.00 <br /> X498'. t �Cl ATE <br /> yf�19� <br /> Please make Checks PAYABLE to: 'EHD' <br /> Penalties will be added to all Permit Fees For HMBP 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 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />