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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 18.68 E•HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> Account to AR00516 <br /> <br /> <br /> rinted 12/12/2022 <br /> KELLEY, JOSEPH RE : FERMENT& GRIND <br /> FERMENT&GRIND 894 GOLDEN POND DR <br /> 894 GOLDEN POND DR MANTECA, CA 95336 <br /> MANTECA, CA 95136 <br /> OWNER : KELLEY, JOSEPH <br /> Date Health <br /> Program De-cription Amount <br /> Invoice# IN0376815--Date of Invoice : 12112/2022 III I IIIIII III IIIII IIIII IIIII IIIII IIIII IIIII I IIIIIII IIIII IIII IIIIII 111111111111 <br /> IIIIIIIIIIII <br /> 12/12/2022 1609 CLASS B COTTAGE FOOD-INDIRECT SALES PRO547456 $ 312.00 <br /> Total for this Invoice $ 312.00 <br /> 1/30/2023 <br /> TOTAL DUE this Billing Period 312.00 <br /> ATTENTION! YOUR CFO PERMIT WILL NOT BE RENEWED BY ONLY PAYING THE INV OU <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 /> hgps://www.si gov.orWdocs/default-source/environmental-health-documents/food-and-restaurants/efo-registration-permittin <br /> e-renewal-form.pdPsfvrsn=d950fb44 5 : https://eccO2.safelinks.protection.outlook.com/? <br /> url=https%3A%2F%2Fwwwslgov.org%2Fdocs%2Fdefault-source%2Fenvironmental-health-documents%2Ffood-and-rests <br /> urants%2Fcfo-registration-DermittinQ-renewal-form.pdf%3Fsfvrsn%3Dd950fb44 5&data=05%7COI%7Cjsalwolke%40sjg <br /> ov.org°/a7COdo58e9dfbee4d8flOc3O8dab2233bdc%7C3cff5O75176a4OOd86Oa5496Oa7c7e51%7C0%7C0°/`7C63801816164 <br /> 0113088%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIioiV 2luMzIiLCJBTiI6Ik 1 haWwiLCJXV CI <br /> 6MnO%3 D%7C3000%7C%7C%7C&sdata=6tReKMC6hxT5tvegQ4bBY 12ImM}7b53zNcmtPtD%2 FYTA%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 /> PAYMENT <br /> RECEIVED <br /> JAN 0 3 2023 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Please make Checks PAYABLE to: 'EHD' <br /> or <br /> Pay online at: 'httos://www.sjoov.org/deoartment/envhealth/fees/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% 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 />