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OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL MANAGEMENT PLAN FEE <br /> CURRENT YEAR (�i �r <br /> BILLING CORRECTION RECORD <br /> Name of BusinessGf� ll�sf 044 EFVDU .� <br /> PrimaryContact 141V>e #6AW,9n Account No. <br /> Facility Mailing Address 4-z// &/&e <br /> ,eel SiGcj, �� 9s2/L <br /> Billing Year That Error Was Made `/J <br /> Amount Originally Invoiced <br /> Original Base Fee/Chemical Count l,E�/a•00 { <br /> Type of Error: [ J Data Entryeview [ ] Other <br /> Nature of Error Sob,uvki oyekoxjI) CyA 4aaEG, Cf(tp <br /> I2gg 171V"00 —TV—M rhs V107- ,,4ct <br /> VV, 10( qs- <br /> Corrected Base Fee/Chemical Count rov <br /> Amount Overcharged <br /> Amount Undercharged /S dZ� <br /> Comments <br /> For Supervisor's Use: Supervisor's Approval— <br /> Actions Taken or Ordered-,00�, 6e xpQ, <br />