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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> COPYAccount ID AR0030084 <br /> INVOICE <br /> Facility ID FA0017202 <br /> Date Printed 9/27/2019 <br /> RE : 441:+20111111111118-aftes <br /> -R6-B )X 686 R" PA. <br /> LODI, CA 95242 <br /> OWNER : T-'O-YI <br /> etre ars <br /> nates Health <br /> I Program Description Amount <br /> Invoice# IN0328711 ---Date of Invoice: 9/26/2019 �111111 1111 E 1111�1111 11111 1EI 111 11111 1111 11111 111 1111 iifl�N11 1111 IN <br /> 9/26/2019 1922 CERS Processing Fee $ 30.00 <br /> 9/26/2019 1958 HM-Farm Operations $ 22.00 <br /> 9/26/2019 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> Total for this Invoice I $ 101.00 <br /> Payment Due Date 10/2712 19 <br /> TOTAL DUE this Billing Period $ 101.00 <br /> 5 <br /> b 0-m e <br /> PAYMENT <br /> RECEIVED <br /> OCT 15 2019 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <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 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.rot <br />