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CAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> AccountlDMA <br /> ate Printed <br /> BLANKENSHIP, SAMANTHA RE : VINTAGE ROAST COFF E <br /> VINTAGE ROAST COFFEE 1125 S LEE AVE <br /> 1125 S LEE AVE LODI, CA 95240 <br /> LODI, CA 95240 <br /> OWNER : BLANKENSI I17 AMANTHA <br /> Dat- Health <br /> Program Description Amount <br /> Invoice# IN0349085--Date of Invoice: 2/25/2021 111111111111111111�ElIIIII IIIII111111111111111IN111111111111111�111 <br /> 2/25/2021 1608 CLASS A COTTAGE FOOD-DIRECT SALES $ 155.00 , <br /> Total for this Invoice $ 155.00 <br /> Payment Due Date 3/30/2021 <br /> TOTAL DUE this Billing Period $ 155.00 <br /> G30CE DD <br /> S 2 2 2021 <br /> ENVI NMENTAL LTH <br /> RMIT/SERVICES <br /> 23121 VLP) LZI SAMII XA N Sa16 sW/ <br /> via P ?A0j Mul -tud 7�. - <br /> Please make Checks PAYABLE to: 'EHD' <br /> or <br /> Pay online at: 'https://vvvvw.siaov.oro/deoartmenUenvhealth/online-payment' <br /> Penalties wit'0" added to all Permit Fees For HMBP Fees For all SERVICE FEES <br /> at the R e 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 mi End of report <br />