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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEA1LTH DEPARTMENT Page <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> Account ID AR0051159 <br /> INVOICE <br /> Return This INVOICE with Your PAYMENT Facility ID FA0026829 <br /> Date Printed 8/29/2023 <br /> ORK, NANCY RE : 143 MY CREATIONS <br /> 143 MY CREATIONS 709 GOTHAM DR <br /> 709 GOTHAM DR STOCKTON, CA 95210 <br /> STOCKTON, CA 95210 <br /> OWNER : ORK, NANCY <br /> Date Health <br /> Program Description Amount <br /> Invoice# ING383225---Date of Invoice: 8/29/2023 11111 11111 11111 11111 IN 111111 11111 1111 IN <br /> 8/29/2023 1608 CLASS A COTTAGE FOOD-DIRECT SALES PR0547254 $ 186.00 <br /> Total for this Invoice $ 186.00 <br /> 913012023 <br /> 00 <br /> OTAL DUE this Billing Perio <br /> .00 <br /> 186OYTATTENTION! YOUR F PERMIT WILLNOTBE RENEWED BY ONLY PA ING THE IN <br /> NEED T COMPLETE AND RETURN THE RENEWAL RM AND INCLUDE A LAN <br /> CFO PRODUCTS.CFO RENEWAL FORM HERE: <br /> hgps•//www sjgov org/docs/default-source/environmental-health-documents/food-and-restaurants/cfo-reilistration-12ermittin <br /> g-renewal-form pdPsfvrsn=d950fb44 5<hqps:Hp-cc02.safelinks.12rotection.outlook.com/? <br /> url=https%3A%2F%2Fwww sjgov orLP/o2Fdocs%2Fdefault-source%2Fenvironmental-health-documents%2Ffood-and-resta <br /> urants%2Fcfo-registration-permitting-renewal-form pdf%3Fsfvrsn%3Dd950fb44 5&data=05%7COI%7Cjsalwolke%40sjg <br /> ov org%7C0d058e9dfbee4d8f10c308dab2233bdc%7C3cff5075176a400d860a54960a7c7e5l%7CO%7CO%7C63801816164 <br /> 01 13088%7CUnknown%7CTWFpbGZsb3d8eyJWIj-oiMC4wLjAwMDAiLCJQljoiV2luMzliLCJBTiI6lk 1 haWwiLCJXVCI <br /> 6MnO%3D%7C3000%7C%7C%7C&sdata=6tRcKMC6hxT5tyggQ4bBY 121mMj7b53zNcmtPtD%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 /> yFq-gz"'90�"NC ?� <br /> T �Y <br /> 041, <br /> Please make Checks PAYABLE to: 'EHD' yOFpq TMFN <br /> or <br /> T <br /> Pay online at: 'https:l/www.sigov.orc/department/envhealth/fees/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 /> ;-I,rnt End of report <br />