Laserfiche WebLink
OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL MANAGEMENT PLAN FEE <br /> ( <br /> CURRENT YEAR % (-� <br /> BILLING CORRECTION RECORD <br /> Name of Business ISG-I j (a li �tea- At S 1 � �� C / r— <br /> Primary Contact Sa v��✓cx L , //fig dN e C -'Account No. <br /> Facility Mailing Address <br /> Billing Year That Error Was Made S <br /> Amount Originally Invoiced <br /> ®o <br /> Original Base Fee/Chemical Count <br /> Type of Error. [ ] Data Entry k Review [/ ] Other <br /> Nature of Error A%F rO ct-vv? �d / ,1 <br /> Corrected Base Fee/Chemical Count <br /> Amount Overcharged <br /> Amount Undercharged <br /> Comments <br /> ---------------------------------------------------------- <br /> ---------------------------------------------------------- <br /> For Supervisor's Use: Supervisor's Approval <br /> Actions Taken or <br /> Ordered <br />