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lwe <br /> OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL MANAGEiNMNT PLAN FEE <br /> CURRENT YEAR L` <br /> BILLING CORRECTION RECORD <br /> Name of Business V <br /> Primary Contact _V Q 1/1 �-c�4- v e • « �r Account No. �r3 <br /> Facility Mailing Address_ 1103 <br /> Billing Year That Error Was Made / SJ <br /> 00 ©rj <br /> Amount Originally Invoiced .3Ts <br /> Original Base Fee/Chemical Count 2 �� <br /> Type of Error: [ j Data Entry [/j Review ] Other Q <br /> Nature of Error _ l R•/- i% Cdc�y ��GP <br /> Corrected Base Fee/Chemical CountZ <br /> m0 <br /> Amount Overcharged /-70 <br /> Amount Undercharged <br /> Comments <br /> --------------------------------------------------------- <br /> ---------------------- <br /> For Supervisor's Use: �I Supervisor's Approval -.L �� <br /> Actions Taken or Ordered <br />