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JOAQUIN COUNTY Page 1 <br /> ONMEN't AL—+ilEALTH DEPARTMENT <br /> = HACELTON AVENUE <br /> KTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> Account ID AR0051616 <br /> INVOICE <br /> Return This INVOICE with Your PAYMENT Facility ID FA0026976 <br /> Date Printed 2/7/2024 <br /> MARTINEZ,ADRIANA RE : ADRI'S COOKIE CO <br /> ADRI'S COOKIE CO 2325 OREGON AVE <br /> 2325 OREGON AVE STOCKTON, CA 95204 <br /> STOCKTON, CA 95204 <br /> OWNER : MARTINEZ,ADRIANA <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0390631 ---Date of Invoice: 12/20/2023 I IIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 12/20/2023 1608 CLASS A COTTAGE FOOD-DIRECT SALES PR0547447 $ 186.00 <br /> Total for this Invoice $ 186.00 <br /> Payment Due Date 1/30/2024 <br /> SECOND NOTICE <br /> TOTAL DUE this Billing PeriodqY _ <br /> ATTENTION! YOUR CFO PERMIT WILL NOT BE RENEWED BY ONLY PAYIN THE INV I <br /> NEED TO COMPLETE AND RETURN THE RENEWAL FORM AND INCLUDE A LABEL OF ONE O YOUR <br /> CFO PRODUCTS. CFO RENEWAL FORM HERE: <br /> https://www.sjizov.or�-,/department/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: jcastaneda(&siaov.org<mailto:jcastaneda n sj og v.org> <br /> V � <br /> Please make Checks PAYABLE to: 'EHD' <br /> or <br /> Pay online at: 'httr)s://www.sagov.orci/departmentienvhealth/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 /> 5254.rpt End of report <br />