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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />18,68 E•HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />Account ID <br />INVOICE <br />Return This INVOICE with Your PAYMENT Facility to <br />Date Printed <br /> <br /> <br /> <br /> <br />OWNER: KELLEY, JOSEPH <br />Page 1 <br />AR0051622 <br />FA0026982 <br />12/12/2022 <br />Date Health <br />Prcaram De:xription Amount I <br />Invoice # IN0376815 -- Date of Invoice : 12112/2022 <br />12/12/2022 1609 CLASS B COTTAGE FOOD -INDIRECT SALES <br />PRO547456 $ 312.00 <br />Total for this Invoice I $ 312.00 <br />1/30/2023 <br />TOTAL DUE this Billing Period <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 />hgps://www.si gov. orWdocs/default-source/environmental-health-documents/food-and-restaurants/efo-registration-permittin <br />e-renewal-form.pdPsfvrsn=d950fb44 5: https://eccO2.safelinks.protection.outlook.com/? <br />url=https%3A%2F%2Fwwwslgov.org%2Fdocs%2Fdefault-source%2Fenvironmental-health-documents%2Ffood-and-rests <br />urants%2Fcfo-registration-DermittinQ-renewal-form.pdf%3Fsfvrsn%3Dd950fb44 5&data=05%7COl%7Cisalwolke%40s'g <br />ov.org°/a7COdo58e9dfbee4d8flOc3O8dab2233bdc%7C3cff5O75176a4OOd86Oa5496Oa7c7e51%7C0%7C0°/`7C63801816164 <br />0113088%7CUnknown%7CTWFpbGZsb3d8eyJ_MioiMC4wLiAwMDAiLCJQIioiV 2luMzIiLCJBTiI6Ik 1 haWwiLCJXV CI <br />6MnO%3 D%703000%7C%n7C%7C&sdata=6tRCKMC6hxT5tveaO4bBY 12lmMi7b53zNcmtPtD%2 FYTA%3 D&reserved= <br />a <br />You can return by mail to our department at the address on the top of your invoice or email completed forms and <br />PAYMENT <br />RECEIVED <br />JAN 0 3 2023 <br />SAN JOAOUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />Please make Checks PAYABLE to: 'EHD' <br />or <br />Pay online at:'httos://www.sjoov.org/deoartment/envhealttdfees/online-fee-Davment' <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 />