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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />ST,OCKTON, CA 95205 <br />Phone: (209) 4683420 <br />Account ID <br />INVOICE <br />Return This INVOICE with Your PAYMENT Facility lD <br />Date Printed <br /> <br /> <br /> <br /> <br />OWNER: SANA, REY <br />Page 1 <br />AR0051528 <br />FA0026946 <br />12/12/2022 <br />Date Health <br />Program Description Amount <br />Invoice # IN0376818 — Date of Invoice : 12/12/2022 <br />12/12/2022 1609 CLASS B COTTAGE FOOD -INDIRECT SALES <br />PRO547400 $ 312.00 <br />Total for this Invoice I $ `a <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 s'gov or2/docs/default-soureclenvironmental-health-documents/food-and-restaurants/cfo-reizistration-permittin <br />g-renewal-form.12df7sfvrsn=d950fb44 5<https://gec02.safelinks.protection.outlook.com/? <br />url=hips%3A%2F%2Fwww sjgov.org%2Fdocs%2Fdefault-source%2Fenvironmental-health-documents%2Ffood-and-resta <br />urants%2Fcfo-registration-permittingrenewal-form.pdf%3Fsfvrsn%3Dd950tb44 5&data=05%7C01%7Cisalwolke%40si <br />ov.org%7COd058e9dfbee4d8f1Oc308dab2233bdc%7C3cff5075176a400d860a54960a7c7e51%7C0%7C0%7C63801816164 <br />0113088%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLiAwMDAiLCJQIioiV2luMzIiLCJBTiI6Ikl haWwiLCJXVCI <br />6Mn0%3D%7C3000%7C%7C%7C&sdata=6tRCKMC6hxT5tvg-oO4bBY12ImMi7b53zNcmtPtD%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 />PA yjo� <br />RCE ED <br />SAN DEC ?? 20ZZ <br />ENJOA <br />EN-rA <br />Please make Checks PAYABLE to: 'EHD' HEALTH <br />EATy O PAR M 7. <br />or <br />Pay online at:'httr)s://www.sigov.oro/departmentlenvhealttvfees/online-fee-Dayment' <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 thereafte <br />5254.rpt .PPO ^ , 7q oo <br />