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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL 1-1EALN DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />Page 1 <br />INVOICE <br />Return This INVOICE with Your PAYMENT <br />Account ID <br />Facility ID <br />Date Printed <br />AR0052927 <br />FA0027457 <br />12/5/2023 <br />FUTCH, MICHELLE S <br />RE: BLESSED GLUTENLESS BAKERY <br />BLESSED GLUTENLESS BAKERY 14811 MANZANITA WAY <br />14811 MANZANITA WAY <br />LOCKEFORD, CA 95237 <br />LOCKEFORD, CA 95237 <br />OWNER: FUTCH, MICHELLE S <br />Date Health <br />Program Description Amount <br />Invoice # IN0389373 --- Date of Invoice : 10/18/2023 <br /> 111111111111111111111111111111111111111111111111011111111111111101111IIIIIIIIIIIII <br />10/18/2023 1609 CLASS B COTTAGE FOOD-INDIRECT SALES PRO548117 486.00 <br />Total for this Invoice <br />Payment Due Date 11/30/2023 <br />SECOND NOTICE <br />)6.00 TOTAL DUE this Billing Period 486.00 <br />ATTENTION! YOUR CFO PERMIT WIL1 NOT BE RENEWED BY ONLY PAYING THE INVO . Y <br />0 <br /> <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 />https://www.sjgov.org/department/envhealthiforms <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: jcastanedasjgov.org_<mailtojcastaneda@sjgov.org> <br />Please make Checks PAYABLE to: 'EHD' <br />or <br />Pay online at: 'https://www.sjciov.oro/deoartmentienvhealthifees/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% <br /> <br />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 />486.00 <br />End of reports 5254.rpt