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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> Account ID AR0053225 <br /> INVOICE <br /> Return This INVOICE with Your PAYMENT Facility ID FAoo2i5ae <br /> Date Printed 2/12/2024 <br /> WARD, NINA L RE: BAKERY THREE TWENTY ONE <br /> BAKERY THREE TWENTY ONE 19916 N IAN CT <br /> PO BOX 290 LOCKEFORD, CA 95237 <br /> LOCKEFORD,CA 95237 <br /> OWNER: WARD, NINA L <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0390823--Date of Invoice: 12/21/2023 I IIIIIIIIIIIII III I VIII VIII IIII IIIIIIIIIII IIIIIIII <br /> 12/21/2023 1608 CLASS A COTTAGE FOOD-DIRECT SALES PR0548269 $ 186.00 <br /> o is Invoice $ 186.00 <br /> 1/30/2024 <br /> SECOND NOTICE <br /> TOTAL DUE this Billing P riod $ 186.00 <br /> ATTENTION! YOUR CFO PERMIT WIC.1. NOT BE RENEWED BY ONLY PAY c THE 1: VOICE. YOU <br /> NEED TO COMPLETE AND RETURN THE RENENYAL FORM AND INCLUDE A( LABEL OF N _ OF YOU <br /> CFO PRODUCTS. CFO RENEWAL FORNI HERE: <br /> litti2s://www.siL,ov.ori-,/dcl)ai-tnicjit/envhealth/foi-i-.Is <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&igov.org<maiIto:jcastaneda(wsjgov.org-> <br /> RECE VES <br /> MAR p-� 2024 <br /> SA" <br /> E�NOH pEP RtMENi <br /> Please make Checks PAYABLE to: 'EHD' <br /> or <br /> Pay online at:'htti)s://www.siciov.orci/department/envhealth/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 />