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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 AR0051592 <br /> <br /> <br /> d 1/24/2023 <br /> HARLESS,JORDAN RE : SUGAR MADE SPECIAL <br /> SUGAR MADE SPECIAL 2336 GRENOBLE DR <br /> 2336 GRENOBLE DR LODI, CA 95242 <br /> LODI, CA 95242 <br /> OWNER : HARLESS,JORDAN <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0376812---Date of Invoice: 12/12/2022 IIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII II IIIIII VIIIIIIIIIII <br /> 12/12/2022 1608 CLASS A COTTAGE FOOD-DIRECT SALES PR0547417 $ 186.00 <br /> Total for this Invoice $ 186.00 <br /> Payment Due Date 113012023 <br /> SECOND NOTICE <br /> TOTAL DUE this Billing Period $ 186.00 <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 sjgov orp/docs/default-source/environmental-health-documents/food-and-restaurants/cfo-rep-istration-permittin <br /> g-renewal-form pdf?sfvrsn=d950tb44 5 <https:Hpcc02.safelinks.protection.outlook.com/? <br /> url=https%3A%2F%2Fwww s,Jgov.or2%2Fdocs%2Fdefault-source%2Fenvironmental-health-documents%2Ffood-and-resta <br /> urants%2Fcfo-registration-permitting-renewal-form.pdf%3Fsfvrsn%3Dd950fb44 5&data=05%7C0I%7Cisalwolke%40sjg <br /> ov.ora%7COd058e9dfbee4d8fl0c308dab2233bdc%7C3cff5075176a400d860a54960a7c7e51%7C0%7C0%7063801816164 <br /> 0113088%7CUnknown%7CTWFpbGZsb3d8eyJ WlioiMC4wLiAwMDAiLCJOIjoiV2luMzIiLCJBTii6Ikl haWwiLCJXVCI <br /> 6Mn0%3 D%7C3000%7C%7C%7C&sdata=6tRcKMC6hxT5tyggo4bBY 121mMj 7b53zNcmtPtD%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 /> Please make Checks PAYABLE to: 'EHD' <br /> or <br /> Pay online at: 'https://www.sigov.oro/deplrtment/envhealtWfees/online-fee-I)avment' <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 100/6 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 P14 54 / qI j End of report <br />