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OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL MANAGEMENT PLAN FEE <br /> CURRENT YEAR 7 6 <br /> BILLING CORRECTION RECORD <br /> n <br /> Name of Business <br /> Primary Contact — Otn0. I-au Account No. S 3s� <br /> Facility Mailing Address 110x7 Oo uy Ir. • S is c-k6LA <br /> Billing Year That Error Was Made 9 / <br /> o® <br /> Amount Originally Invoiced /n_. ' <br /> Original Base Fee/Chemical Cou 24©� t 7 0 �. <br /> Type of Error: [ ] Data Entry Re//view [ ] Other <br /> Nature of Error 7 4-12 <br /> !� eq • J ✓ /72 P.4Z //atll /Q0/ 1r1 /5' <br /> Corrected Base Fee/Chem246ical Coun/ 9- S� GGA <br /> Amount Overcharged <br /> Amounts Undercharged <br /> Comments <br />