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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />18613 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Phone: (209) 468-3420 <br />Page 1 <br />INVOICE <br />Return This INVOICE with Your PAYMENT <br />Account ID <br />Facility ID <br />Date Printed <br />AR0052164 <br />FA0027185 <br />5/2/2023 <br />VALADEZ, LISSETTE <br />CAFECALLI ROASTER <br />410 PALM CIR <br />TRACY, CA 95376 <br />RE: CAFECALLI ROASTER <br />410 PALM CIR <br />TRACY, CA 95376 <br />OWNER: VALADEZ, LISSETTE <br />Date Health <br />Program Description Amount <br />Invoice # IN0378864 --- Date of Invoice: 3/28/2023 <br /> 11110111111111111111111111111111111111111111111111111111111110111111111111111111111 <br />3/28/2023 1609 CLASS B COTTAGE FOOD-INDIRECT SALES PRO547731 312.00 <br /> <br />Total for this Invoice 312.00 <br /> <br />Payment Due Date 4/30/2023 <br />SECOND NOTICE <br /> <br />TOTAL DUE this Billing Period' $ 312.00 <br /> <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.sov.org/docs/de fault-source/env ironmental-health-doc uments/food-and-restaurants/c fo-re g istration-perm ittin <br />g-renewal-form.pdf?sfvrsn=d950f1344_5 <https://gcc02.safelinks.protection.outlook.com/? <br />url=https%3A%2F%2Fwww.sjgov.org%2Fdocs%2Fdefault-source%2Fenvironmental-health-documents%2Ffood-and-resta <br />urants%2Fcfo-registration-permitting-renewal-form.pdf%3Fsfvrsn%3Dd950fb44_5&data=05%7C01%7Cjsalwolke%40sjg <br />ov.org%7C0d058e9dfbee4d8f10c308dab2233bdc%7C3cff5075176a400d860a54960a7c7e51%7C0%7C0%7C63801816164 <br />0113088%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2IuMzIiLCJBTil6Ik1haWw iLCJXVCI <br />6Mn0%3D%7C3000%7C%7C%7C&sdata=6tRcKMC6hxT5tygqQ4bBY12ImMj7b53zNcmtPtD%2FYTA%3D&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 />21 2- 4/2 03 <br />orr 1(,, O2I.9 <br />7 <br />Please make Checks PAYABLE to: 'END' <br />or <br />Pay online at: 'httos://vvww.sjgov.org/department/envhealthifees/online-fee-payment <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 60 Days after the Invoice Date and each 30 Days thereafter <br />5254.rpt End of report