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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA <br /> <br /> R0047091 <br /> INVOICE <br /> Facility ID FA0025061 <br /> Date Printed -1/31/2020 <br /> RUIZ, JORDYN T RE : JORDYNS SWEET TREATS <br /> JORDYNS SWEET TREATS 521 GRAPEVINE PL <br /> 521 GRAPEVINE PL LATHROP, CA 95330 <br /> LATHROP, CA 95330 <br /> OWNER : RUIZ, JORDYN T <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0332794---Date of Invoice: 11/26/2019 1111111 E111 H 11111 11111�1111 111 111 11111 11111 11111 C111 1111 11111�1111�1111 IN <br /> 11/26/2019 1608 CLASS A COTTAGE FOOD-DIRECT SALES $ 155.00 <br /> Total for this Invoice $ 155.00 <br /> Payment Due Date 12/27/2019 <br /> TOTAL DUE this Billing Period 155.00 <br /> PA <br /> FC,ejVr._16 <br /> r <br /> SqN JO N '� 17020 <br /> N4NT/5'ONM orAu ry <br /> H 0EP MINT <br /> Ked <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 ? n�4U 01v3 15 <br />