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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />AcccuntlD <br />INVOICE <br />Return This INVOICE with Your PAYMENT Facility I <br />Date Printed <br /> <br /> <br /> <br /> <br />OWNER: RUIZ, JORDYN T <br />Page 1 <br />AR0047091 <br />LENEEMMMMMMOM <br />FA0025061 <br />1/21/2022 <br />LEMENNEENNUMEMEMM <br />Date Health <br />Program Description Amount <br />Invoice # IN0362291 --- Date of Invoice : 11/3012021 <br />11/30/2021 1608 CLASS A COTTAGE FOOD -DIRECT SALES <br />SECOND NOTICE <br />� III /III 111111 III IIIII I III I IIIII IIIII III II IIIII ����� II III IIIII III I III III /III I /III /III <br />PR0544063 $ 155.00 <br />Total for this Invoice $ <br />Payment Due Date <br />TOTAL DUE this Billing Period <br />I oo.uu <br />1213012021 <br />2 1 301 2 021 <br />155.00 <br />Important! Cottage Permits require application with every renewal annually. Please download a d fill out the <br />form at this link to be turned into EHD in order to receive your permit. <br />httos://www.sigov.org/department/envhealth/forms <br />Pot, <br />C ofic <br />4 1 s -s V► 812, <br />'It I37`L1g 325' <br />\ �Q/V <br />Would you like Invoices electronically or need to update the email address for this account? Fill out the <br />form below with the information with up to 2 email addresses: <br />Email 1 <br />Email 2 <br />Please make Checks PAYABLE to: 'EHD' or <br />Pay online at:'httos://www.sioov.oro/department/envhealtWonline•r)avment' <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 End of repon <br />