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SAN JOAQUIN COUNTY ENVIRONMENTAL HEAL-tH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209) 468-3420 <br /> Account ID AR0052927 <br /> INVOICE <br /> Return This INVOICE with Your PAYMENT Facility ID FA0027457 <br /> Date Printed 12/5/2023 <br /> FUTCH, MICHELLE S RE : BLESSED GLUTENLESS BAKERY <br /> BLESSED GLUTENLESS BAKERY 14811 MANZANITA WAY <br /> 14811 MANZANITA WAY 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 111111111111111111111111 IN <br /> 10/18/2023 1609 CLASS B COTTAGE FOOD-INDIRECT SALES PR0548117 $ 486.00 <br /> Total for this Invoice $ 486.00 <br /> Payment Due Date 11/30/2023 <br /> SECOND NOTICE <br /> TOTAL DUE this Billing Period 486.00 <br /> ATTENTION! YOUR CFO PERMIT WILLNOTBE RENEWED BY ONLY PAYING THE INV Y <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.orgJdepartment/envhealtli/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(n�si� eov.or,g<mailto:jcastaneda&sihov.org_> <br /> RE Y�FIvP <br /> �%qN��C 85 20?3 <br /> FNV'gQUIN <br /> N CTy�7 cou <br /> NT <br /> Please make Checks PAYABLE to: 'EHD' <br /> or <br /> Pay online at: 'https://www.sjaov.orci/department/envhealtivfees/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 thereafter <br /> 5254,rPt End of report�. <br />