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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1,768 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 6 1 33q <br /> Phone: (209) 468-3420 P <br /> Account ID AR0046050 <br /> INVOICED13 <br /> �j Of <br /> Facility ID FA0024636D Va� Date Printed 7/11/2019 <br /> DAVALOS, GYNAE RE : SUGA RUSHD <br /> SUGA RUSHD 10940 WILDBERRY LN <br /> 10940 WILDBERRY LN STOCKTON, CA 95209 <br /> STOCKTON, CA 95209 <br /> OWNER : DAVALOS, GYNAE <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0320480---Date of Invoice: 3/25/2019 11111 11111 11111 IN 111111 11111 1111 1111 <br /> 3/25/2019 1608 CLASS A COTTAGE FOOD-DIRECT SALES $ 155.00 <br /> 6/15/2019 9994 PERMIT FEE PENALTY $ 155.00 <br /> Total for this Invoice I $ 310.00 <br /> PAST DUE <br /> TOTAL DUE this Billing Period $ 310.00 <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.rpt <br />