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SAN JOAQUIN COUNTY <br /> EN`LIRONMENTAL HEALTH DEPARTME�'T Page 1 <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 <br /> Phone: (209) 468-3420 <br /> INVOICE AccountlD AR0003775� <br /> Facility ID FA0004113.I <br /> Date Printed j 4/14/2009 <br /> A SAMBADO & SON INC RE : A SAMBADO &SON 39-321 <br /> A SAMBADO & SON 39-321 14000 E EIGHT MILE RD <br /> 8077 N TULLY RD LINDEN, CA 95236 <br /> LINDEN, CA 95236 <br /> OWNER : SAMBADO, LAWRENCE <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0183361 ---Date of Invoice: 1/5/2009 I IIIIIII IIIII III IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIIIIIIIIIIIIIIIII IIII IIII <br /> 1/5/2009 2755 EMPLOYEE HOUSING $155.00 <br /> 1/5/2009 9999 PAYMENT ($155.00) <br /> 4/14/2009 2765 EMPLOYEE HOUSING-PERMANENT>180 DAYS $60.00 <br /> Total for this Invoice $60.00 <br /> Payment Due Date 5/14/2009 <br /> TOTAL DUE this Billing Period $ 60.00 <br /> It has been determined you have 15 employees. On 1/5/09 you paid for 10 employees. <br /> This invoice is for the additional 5 employees. If you have any questions, please contact <br /> this office. <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 DES/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 Days after the Invoice Date and each 30 Days thereafter <br /> j2i4.rpt <br />