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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 /> Account ID AR0047493 <br /> <br /> <br /> 9/28/2021 <br /> BLANKENSHIP, SAMANTHA RE : VINTAGE ROAST COFFEE <br /> VINTAGE ROAST COFFEE 1125 S LEE AVE <br /> 1125 S LEE AVE LODI, CA 95240 <br /> LODI, CA 95240 <br /> OWNER : BLANKENSHIP, SAMANTHA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0349085---Date of Invoice: 2125/2021 1111II IVIIVIVII VVIVI VIVIIVII 1111111111111111111 IN <br /> 2/25/2021 1608 CLASS A COTTAGE FOOD-DIRECT SALES PR0544401 $ 155.00 <br /> Total for this Invoice $ 155.00 <br /> Payment Due Date 3/30/2021 <br /> ATTENTION PAST DUE! <br /> YOUR HEALTH PERMIT Delinquent charges over <br /> FOR THE CURRENT YEAR 90 days! <br /> MAY NOT BE ISSUED UNTIL <br /> PAST DUE AMOUNTS ARE <br /> PAID IN FULL <br /> TOTAL DUE this Billing Period 155.00 <br /> Important! Cottage Permits require application with every renewal annually. Please download and fill out the <br /> form at this link to be turned into EHD in order to receive your permit. <br /> httos://www.s igov.org/u ploadedfi les/sic/dei3a rtments/ehd/forms/cfo%20ree-permitting%20renewal%20form.odf <br /> ( onC I322L47© 7°� <br /> eo <br /> Would you like Invoices electronically r need to update the email address for this account?Fill out the <br /> form below or Email us at EH-Invoices@sjgov.org 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.siaovhttos: www. .oridepartment/envhealtIVonlineoaymentPayment' <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 /> 52�4.rpt k 45M 140End of report <br />