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Health <br />Program Description Amount Date <br />SAN JOAQUIN COUNTY <br />EtiVIROWENTAL HEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />Page 2 <br />Account ID AR0049410 <br />INVOICE <br />Return This INVOICE with Your PAYMENT <br /> <br />Facility ID 1 FA0026082 fl <br /> <br />Date Printed 10/2/2023 <br /> <br />MOORE, KRISTINA <br />ON YOUR WAY MINI DONUTS <br />5225 TRIMONTI CIR <br />ANTIOCH, CA 94531-8726 <br />RE: ON YOUR WAY MINI DONUTS <br />19690 N HVVY 99 #170 <br />ACAMPO, CA 95220 <br />OWNER: MOORE, KRISTINA <br />PAST DUE <br />-'OUR HEALTH PERMIT Deliquent charges (o7ZY <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 <br /> <br />$ 356.20 <br /> <br />ATTENTION! YOUR CFO PERMIT WILL I \ Zic BE RENEWED BY ONLY PAYING THE INVOICE. YOU <br />NEED TO COMPLETE AND RETURN THE RENEWAL FORM AND INCLUDE A LABEL OF ONE OF YOUR <br />CFO PRODUCTS. CFO RENEWAL FORM HERE: <br />littps://www.sigov.orOcleuartment/envhealth/forms <br />You can return by mail to our department at the address on the top of your invoice or email completed forms and <br />confirmation of payment to: icastaneclasiczov.orz <mailto:jcastanedasj.,zov.org> <br />Please make Checks PAYABLE to: 'EFID' <br />or <br />Pay online at: 'https://www.sjgov.orgidepartment/envhealth/feesionline-fee-paymenr <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 <br />Penalties will be added at the Rate of 10% <br />Penalties will be added at the Rate of 10% <br />30 Days after the Due Date 60 Days after the Invoice Date <br />60 Days after the Invoice Date and each 30 Days thereafter <br />ATTENT1CN <br />pig DT-iwilLp 5254.rpt End of report