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SAN JOA00I N LOCAL <br /> (-.N V I Rt)NMFN T AL HEAL,"H H ( IVISION <br /> lf'C+I E. HAZELTON AVE . ; cupy <br /> F U [IOX 4r:rr+`Zr STOCkTON, CA 952(ii <br /> T <br /> DIEL FOR SLG- �rT-( Cvi TO C—Al?L CILC t <br /> OR SERVICES RENDERED <br /> TIME MINIMUM FOR EACH INSPECTION—I HOUR. q <br /> DDI <br /> WILL. BE COMPUTED TO NEAREST I/' HOUR INCLUDINGTTRAVEL INSPECTION TIME <br /> NO'rE : <br /> PRIOR TO TIME. <br /> AS SPECIFIED ON AHE PERMIT TAPPL I CATOI ON�CTOFlS ARE kEQU I FcED TO GIVE NO'r I CE <br /> S I'rUS ADDRESS: ( L) S ;r <br /> (P�kM I r �Y� <br /> BILL T O: NAME <br /> ADDRESS 3 S S <br /> ------------ <br /> /,nom <br /> CITY/STATE / _S <br /> ZIP <br /> PROGRAM: <br /> DESCfi I PT i ON <br /> OF SERVICE(S) : <br /> DATE TOTAL <br /> OF WEEKDAYS WEEF::NIGHTS ' WEEKENDS/HOLIDAYS <br /> SERVICE BAM-4 :-:CiPm 4 :3 0PM_OAM SAN I TAR I Ah! <br /> HRS WORKED $-5/HR <br /> '$52. 50/HR $70/HR <br /> { I <br /> I <br /> 1 <br /> " I <br /> I!ALANL;L I)UE ---- <br /> BILLING DArE - <br /> r-+ DAY'.; �:I UMw - _ PAYMEN i IS 1`0 HE RECEIVED W I TH I N <br /> IHE BILLING DAIS . <br /> RETURN ONE (:OPY Op: <br /> r0: THIS BILL. ALUNG WITH F•AYMI:Nl , MAKF C"EC O-'-S PAYALA-L <br /> SAN ,IUAOU 1 N LUC:AI HEAL 1 H I)I S 1 R I C T . <br /> IAA l (}U - <br /> r <br />