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Account ID AR0051829 <br />Facility ID FA0027060 <br />Date Printed 3/3/2023 <br />INVOICE <br />Return This INVOICE with Your PAYMENT <br />I <br />C <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E HAZELTON AVENUE <br />STOC,KTON,•CA 95205 <br />Phone: (209) 468-3420 <br />Page 1 <br />BAILEY, POOLE R <br />ASH BLOSSOM BAKERY <br />402 QUAIL RUN CIR <br />TRACY, CA 95377 <br />RE: ASH BLOSSOM BAKERY <br />402 QUAIL RUN CIR <br />TRACY, CA 95377 <br />OWNER: POOLE, BAILEY R <br />Date Health <br />Program Description Amount <br />Invoice # IN0377825 --- Date of Invoice: 2/16/2023 <br />2/16/2023 1608 CLASS A COTTAGE FOOD-DIRECT SALES <br />AHEM 101111011110 11111101 WU VIEN HIMVIN0111 <br />PR0547567 $ 186.00 <br />Total for this Invoice <br />Payment Due Date 3/30/2023 <br />186.00 <br />TOTAL DUE this Billing Period $ 186.00 <br /> <br />ATTENTION! YOUR CFO PERMIT WILL NOTIM 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 />https://www.sjgov.org/docs/default-source/environmental-health-documents/food-and-restaurants/cfo-registration-Permittin <br />g-renewal-form.pdf?sfvrsn=d950fb44_5 <https://gcc02.safelinks.protection.outlook.com/? <br />url=https%3A%2F%2Fwww.sjgov.org%2Fdocs%2Fdefault-source%2Fenvironmental-health-documents%2 Ffo0d-and-resta <br />urants%2Fcfo-registration-perm itting-renewal-form.pdf%3Fsfvrsn%3Dd9501b44 5&data=05%7C01%7Cjsalwolke%40sjg <br />ov.org%7C0d058e9dfbee4d8f10c308dab2233bdc%7C3cff5075176a400d860a54960a7c7e51%7C0%7C 0%7C63801816164 <br />0113088%7CUnknown%7CTWFpbGZsb3 d8eyJWI jo iMC4wLjAwMDAiLCJQIjo iV2 luMzI iLCJBTiI6Ik1haWw iLCJXVCI <br />6Mn0%3D%7C3000%7C%7C%7C&sdata=6tRcKMC6hxT5tygqQ4bBY12ImMj7b53zNcmtPtD%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 />/ilStC, 24c/23 <br />1 5-733/ G-3 -1 <br />Please make Checks PAYABLE to: 'EHD' <br />or <br />Pay online at: 'https://www.si_gov.org/deoartmentienvhealthifeesionline-fee-Davmente <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 /> Penalties will be added at the Rate of 10% <br />30 Days after the Due Date 60 Days after the Invoice Date <br /> 60 Days after the Invoice Date and each 30 Days thereafter <br />5254.rpt End of report