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SAN JOAQUIN COUNTY <br /> Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> Account ID —AR <br /> <br /> <br /> Date Printed 3/8/2023 <br /> LENEEEEEEMENMMB <br /> FEDOR,ALLISON RE : SCRUMP CANDY CO <br /> SCRUMP CANDY CO 18083 N RIPON RD <br /> PO BOX 508 RIPON, CA 95366 <br /> COVELO, CA 95428 <br /> OWNER : FEDOR,ALLISON <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0377828---Date of Invoice: 2/16/2023 11111111 HIM III IIIII IIIII IIIII IIIII 1111111111111111111111111 IN 1111111111111111111 <br /> 2/16/2023 1608 CLASS A COTTAGE FOOD-DIRECT SALES PR0547585 $ 186.00 <br /> Total for this Invoice $ 186.00 <br /> Payment Due Date 3/3012023 <br /> TOTAL DUE this Billing Period $ 186.00 <br /> ATTENTION! YOUR CFO PERMIT WILL NOT BE RENEWED BY ONLY PAYING THE INVOICE. YOU <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 /> h_ptt s://www sigov.org/docs/default-source/environmental-health-documents/food-and-restaurants/cfo-reeistration-perrnittin <br /> 2-renewal-form.pdf?sfvrsn=d950fb44 5 <htti2s:Hiacc02.safelinks.protection.outlook.com/? <br /> url=https%3A%2F%2Fwww.sj ov.orZ%2Fdocs%2Fdefault-source%2Fenvironmental-health-documents%2Ffood-and-rests <br /> urants%2Fcfo-reaistration-permitting-renewal-form.pdf%3Fsfvrsn%3Dd950fb44 5&data=05%7COI%7Cjsalwolke%40sm <br /> ov.org%7COd058e9dfbee4d8fl Oc3O8dab2233bdc%7C3cff5075176a40Od860a5496Oa7c7e5l%7C0%7CO%7063801816164 <br /> 0113088%7CUnknown%7CTW FpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJOIjoiV2luMZliLCJBTil6lk l haWwiLCJXVCI <br /> 6Mn0%3 D%703000%7C%7C%7C&sdata=6tRcKMC6hxT5tyggO4bBY 12lmMj7b53zN cmtP'tD%2FYTA%3 D&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 /> PC) I'd � / 36 212 O/a 3 <br /> Cook' 4 1 5 7H77 63c <br /> Please make Checks PAYABLE to: 'EHD' <br /> or <br /> Pay online at: 'httos:/Iwww.sigov.orgldepartmenUenvhealth/fees/online-fee-oavmen <br /> t' <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 V (cL_ S End of report <br />