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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 AR0049408 <br /> INVOICE <br /> Return This INVOICE with Your PAYMENT Facility ID FA0026080 <br /> Date Printed 8/4/2023 <br /> HOLLOWAY-DYER, CARROL RE : A GREEN ZONE C <br /> A GREEN ZONE C 2356 BEARDSLEY AVE <br /> 2356 BEARDSLEY AVE MANTECA, CA 95337 <br /> MANTECA, CA 95337 <br /> OWNER : HOLLOWAY-DYER, CARROL <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0381959---Date of Invoice: 6/28/2023 1111111 111111 V 11111 11111 1$11111 11111 11111 111�1111 11111 1111 111111 11111 1111 IN <br /> 6/28/2023 1609 CLASS B COTTAGE FOOD-INDIRECT SALES PR0546114 $ 312.00 <br /> Total for this Invoice $ 312.00 <br /> Payment Due Date 7/30/2023 <br /> SECOND NOTICE <br /> TOTAL DUE this Billing Pe od $ 312.00 <br /> ATTENTION! F PERMIT WILL NOT BE RENEWED BY ONLY PAYIN THE INV ICE. Yo <br /> NEED TO COMPLETE AND RETURN THE RENEWAL FORM AND INCLUDE A LABEL OF NE UR <br /> CFO PRODUCTS. CFO RENEWAL FORM HERE: <br /> https•//www sIgov orp/docs/default-source/environmental-health-documents/food-and-restaurants/cfo-registration-12ermittin <br /> g-renewal-form.pdf'?sfvrsn=d950fb44_55 <hM2s:H2cc02.safelinks.protection.outlook.com/? <br /> url=https%3 A%2F%2Fwww.sigov.org%2Fdocs%2 Fdefault-source%2Fenv ironmental-health-doc uments%2Ffood-and-recta <br /> urants%2Fcfo-registration-permitting-renewal-form pdf%3Fsfvrsn%3Dd950fb44 5&data=05%7C01%7Cjsalwolke%40sjg <br /> ov org%7C0d058e9dfbee4d8f10c308dab2233bdc%7C3cff5075176a400d860a54960a7c7e51%7C0%7C0%7C63801816164 <br /> 0113088%7CUnknown%7CTWF12bGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJOIjoiV2luMzliLCJBTiI61k1 haWwiLCJXVCI <br /> 6Mn0%3D%7C3000%7C%7C%7C&sdata=6tRcKMC6hxT5tygg04bBY 12ImMj7b53zNcmtPtD%2FYTA%3D&reserved= <br /> 0> <br /> You can return by mail to our department at the address on the top of your invoice or email completed forms and <br /> 5l2� 7/2- 11,7 3 <br /> � <br /> Please make Checks PAYAB E to: 'EHD' <br /> or <br /> Pay online at: 'https://www.sjgov.orQ/department/envhealt[Vfees/online-fee-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 End of report <br />