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1 <br /> SAN JUAOUIN LOCAL HE*ALTH DISTRICT <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1601 E. HAZELTON AVE. ._ <br /> P U BOX 2oi)9, STOCK"TON, CA 9501 <br /> BILL FOR SERVICES RENDERED <br /> r <br /> TIME MINIMUM FOR EACH INSPECTION-1 HOUR. ADDITIONAL INSPECTION TIME # <br /> F WILL BE COMPUTED TO NEAREST 1/2 HOUR INCLUDING TRAVEL TIME. <br /> NOTE: PRIOR TO ALL INSPECTIONS, CONTRACTORS ARE REQUIRED TO GIVE NOTICE <br /> AS SPECIFIED ON THE PERMIT APPLICATION. <br /> . S I'TUS ADDRESS:- Z( 5bo S . C f PERM I T # �LY� <br /> BILL TO: NAME YLb <br /> ADDRESSI Ob_ _ -ppzEt'36I(5 Ave 56 1 , G _ <br /> CITY/STATE.. _-WA4.),i Cja-=L ZIP QuSZIGa "35� <br /> PROGRAM: epw uS ("_)ast <br /> I�� <br /> DESCRIPTION OF SERVICE(S) : �`-tmC rte", <br /> rn- <br /> i <br /> DATE TOTAL WEEKDAYS WEEKNIGHTS WEEKENDS/HOLIDAYS SANITARIAN <br /> OF SAM-4:3GPM 4:30PM-SAM ---, ; <br /> SERVICE HRS WORKED $35/HR $52.50/HR $70/HR' <br />..z.,.r,.i.r x�,. .4 ... .. -a, .., `.ref •.: ... _ . - , .- •,K.:.:n-.•:. .,.N ,. _ .. ., ;. ....r.' ,•M-t.,d.:•w. <br /> 6'r, <br /> 7 <br /> 8 <br /> 4 " .. <br /> _.... __. __ ----._�-..__�� ---cl,3 0=/0,30 <br /> IL6AIUG -3;00 <br /> BALANCE DUE: ! 3 <br /> BILLING DATE PAYMENT IS TO BE RECEIVED WITHIN <br /> .30 DAYS FROM THE PILLING DATE. <br /> RETURN ONE COPY OF THIS BILL ALONG WITH PAYMENT„ MAKE CHECKS PAYABLE <br /> TO: SAN J,OAQU.IN LOCAL HEALTH DISTRICT. <br /> EH 00 43 <br />