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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 IDAR0053201 <br /> INVOICE � 4 =" <br /> Facility ID FA00275 <br /> Return This INVOICE with Your PAYMENT 2 <br /> � ' __:.. - <br /> Date Printed 12/21/20237' <br /> CHARLES, LAJEANA RE: GI HOLISTICS <br /> GI HOLISTICS 2315 ALAMO CT <br /> 2315 ALAMO CT TRACY, CA 95377 <br /> TRACY, CA 95377 <br /> OWNER : CHARLES, LAJEANA M <br /> Date Health <br /> Program Description _ <br /> -Amount I <br /> Invoice# IN0390817--Date of invoice: 12/2112023 ll��IIIIIIIIIIIIIIII��IIII'I�III"I�ll�I��IIIIIII��f1I11III1II1fill Hill lllllfill IN <br /> 12/21/2023 1608 CLASS A COTTAGE FOOD-DIRECT SALES I PRO548245 $ 1186.00 <br /> Total for this Invoice $ 186.00 <br /> 1/30/2024 <br /> TOTAL DUE this Billing Period $ 186.00 <br /> ATTENTION! YOUR CFO PERIIIIT 1YILL _ BE RENENVED BY ONLI' PAYING THE INVOICE. YOU <br /> NEED TO COMPLETE AND RETURN THE RENE'AAL FORNI AND INCLUDE A LABEL OF ONE OF YOUR <br /> CFO PRODUCTS. CFO RENE`YAI. FORM HERE: <br /> s-Liov.0i�denaltnient'ennhealth'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 /> confirmationofpaymentto: i(astaned(1`iCSj�OV.QI� ' Ill'n11t0:,1i0�i811ct�a(i7•cio;i� r:� <br /> 1266 <br /> LA)EAN A M CHARLES 111:268/1210 4363 <br /> 2315 Alamo Ct <br /> Tracy,CA 95377-1139 ate <br /> ) � <br /> Pay to the <br /> of Pais <br /> t':e:ls�ar50 Sank,N <br /> cc3fo-nJ <br /> ..'Is`.arSaco^ <br /> For �15 <br /> 0 L 266 <br /> AYE <br /> _ -- or — -- <br /> Pay online at:'fl'i JS:ii`,,,IJAii.Si }6?J.o_G:G2nai ieil8i;i/el:, ep.1-i-./'legs/Oiaiif-ic-iee--DZViilf-. St' <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 <br /> End of report <br />