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OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL MANAGEMENT PLAN FEE -- <br /> CURRENT YEAR 9 (� <br /> n 1 <br /> BILLING CORRECTION RECORD <br /> Name of Business Por% <br /> Primary Contact TUezvl J!/P_d'a. v /Account No. l 7 3 <br /> Facility Mailing Address /_ `100- ?OK 11 S� C_1<70v4/ <br /> Billing Year That Error Was Made 7 <br /> on <br /> Amovnt Originally Invoiced <br /> Original Base Fee/Chemical Count o2 VO 5 <br /> Type of Error: [ ] Data Entry XReview [ ] Other <br /> Nature of Error_Loc a ea- 7L aj�rr �P /7 ej <br /> 0/ <br /> Corrected Base Fee/Chemical Count Z�S— <br /> 3 <br /> Amount Overcharged <br /> Amount Undercharged <br /> Comments <br />