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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1-868 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 Prin d <br />AR0048584 <br />FA0025696 <br />1/23/2023 I <br />AMBATALI, HAZEL <br />PINOYDASH.COM <br />68 MAGNETITE AVE <br />LATHROP, CA 95330 <br />RE: PINOYDASH.COM <br />68 MAGNETITE AVE <br />LATHROP, CA 95330 <br />OWNER: AMBATALI, HAZEL <br />Date Health <br />Program Description Amount <br />Invoice # IN0376807 --- Date of Invoice : 12/12/2022 <br /> 11111111111111111111111111111111111111111111111111111111111 1111111111111111111 1111 <br />12/12/2022 1608 CLASS A COTTAGE FOOD-DIRECT SALES <br /> PRO545176 186.00 <br />Total for this Invoice <br />Payment Due Date 1/30/2023 <br />SECOND NOTICE <br /> <br />TOTAL DUE this Billing Period' $ / 186.00 <br /> <br />ATTENTION! YOUR CFO PERMIT WILL NOT BE RENEWED BY ONLY PAYING THE INVOI YO,TY <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/env ironmental-health-doc uments/food-and-restaurants/cfo-reg istration- perm ittin <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%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%7CTWFpbGZsb3d8eyJWIj0iMC4wLjAwMDAiLCJOIjoiV2IuMzliLCJBTil6Ik1haWwiLCJXVCI <br />6Mn0%3D%7C3000%7C%7C%7C&sdata=6tRcKMC6hxT5tygqQ4bBY121mMj7b53zNcmtPtD%2FYTA%3D&reserved= <br />o> <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 23 2023 <br />SAN JOAQUIN COUN rY <br />ENVIRONMENTAL <br />'liii TH 1,1,1 .11-,1 <br />Please make Checks PAYABLE to: 'EHD' <br />or <br />Pay online at: 'https://www.sigov.orgideoartmentienvhealth/feesionline-fee-oayment' <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 />186.00 <br />5254.rpt End of report