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Noe <br /> OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL MANAGEMi 7 PLAN FEE <br /> CURRENT YEAR—JC? <br /> BILLING CORRECTION RECORD <br /> Name of Business 0 A(-P--j o .,.A A uJo L ems-,1 <br /> PrimaryContact Account No. Fo S 7 <br /> Facility Mailing Address C-1 <br /> Billing Year That Error Was Made <br /> Amount Originally Invoiced <br /> om ID IJ <br /> Original Base Fee/Chemical Count <br /> Type of Error: ( ] Data Entry x Review [ ] Other <br /> Nature of Error {—re_o✓\ , c� l bS (' 0�2vtTe0� <br /> lyi <br /> Corrected Base Fee/Chemical Count <br /> Amount Overcharged 5 <br /> Amount Undercharged 11 <br /> Commeats -- r V�ela <br /> V' (� ` C O U V1 i Yi <br /> i � GLt ( L3t)L- <br /> ------------------------------ <br /> For Supervisor's Use: Supervisor's Approval�> <br /> Actions Taken or Ordered �f�� f <br />