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j <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH DIVISION O <br /> 1601 E. HAZELTON AVE. . <br /> P O BOX 2009, STOCKTON, CA 952201 I �] <br /> HILL FOR SERVICES RENDERED <br /> I <br /> TIME MINIMUM FOR EACH INSPECTION-.L HOUR. ADDITIONAL INSPECTION TIME <br /> WILL. BE COMPUTED TO NEAREST 1/2 HOUR INCLUDING TRAVEL TIME. <br /> u , <br /> NOTE: PRIOR TO ALL INSPECTIONS, CONTRACTORS ARE REQUIRED TO GIVE NOTICE <br /> AS SPECIFIED ON THE PERMIT APPLICATION. <br /> S I,TUS ADDRESS: —PERMIT #S7' <br /> HILL. TO: NAME <br /> ADDRESS �Il1Jy! U <br /> CITY/STATE G�.I' � C� ZIP <br /> PROGRAM: <br /> DESCRIPTION '-OF SERVICE(S) : <br /> DATE TOTAL WEEKDAYS WEEKNIGHTS WEEKENDS/HOLIDAYS SANITARIAN <br /> OF 8AM-4:30PM 4:30PM--BAM <br /> SERVICE HRS WORKED $35/HR $52. 50/HR $70/HR <br /> t03— <br /> if0TA, <br /> L5-- <br /> BALANCE DUE: A-4— -- - <br /> . <br /> BILLING DATE PAYMENT is T[3 BE RECEIVED WITHIN <br /> DAYS FROM THE BILLING DATE . -- <br /> RETURN ONE COPY OF THIS HILL ALONG WITH PAYMENI , MAKE CHECK'S PAYAB-E <br /> TO: SAN JOAQUIN LOCAL. HEALTH DISTRICT . <br /> 43 <br />