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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 AR0051622 <br /> INVOICE <br /> Return This INVOICE with Your PAYMENT Facility ID FA0026982 <br /> Date Printed 12/20/2023 <br /> KELLEY, JOSEPH RE : FERMENT& GRIND <br /> FERMENT 8r GRIND 894 GOLDEN POND DR <br /> 894 GOLDEN POND DR MANTECA, CA 95336 <br /> MANTECA, CA 95336 <br /> OWNER : KELLEY, JOSEPH <br /> Date <br /> I lealth <br /> Program Description Amourt <br /> i <br /> Invoice# IN0390632---Date of Invoice: 12/20/2023 1111111 H l E 111111111111111111111111 111111E 11111111111111111111111H IN <br /> 12/20/2023 1609 CLASS B COTTAGE FOOD-INDIRECT SALES PR0547456 $ 486.00 <br /> Total for this Invoice $ 486.00 <br /> 1/30/2024 <br /> TOTAL DUE this Billing Period $ 486.00 <br /> ATTENTION! YOUR CFO PERMIT WILL NOT BE 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.s-jgov.orv-/department/envhealth/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: jcastanedaLdsigov.org <mailto:icastanedaLusit?ov.org> <br /> ' U <br /> PAYMENT <br /> ti RECEIVED <br /> 1 JA N 16 2023 <br /> SAN JOAQUIN COUNTY <br /> ENVIROMENTAL <br /> HEALTH DE ARTMENT <br /> Please make Checks PAYABLE to: 'EHD' <br /> or <br /> Pay online at: 'httos://www.sjgov.org/department/envhealttvfees/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 />