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OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL MANAGEMENT PLAN FEE <br /> CURRENT YEAR 9 <br /> BILLING CORRECTION RECORD <br /> i <br /> Name of Business �G / �� LJ c/ cc K S , �� C - / <br /> PrimaryContact _SG ��ct ✓c //.�l�tzs AccountNo.. b Z?S— <br /> Facility Mailing Address <br /> Billing Year That Error Was Made 5 <br /> Amount Originally Invoiced / / `7 <br /> Original Base Fee/Chemical Count <br /> Type of Error: [ ] Data Entry kReview1[ ] Other <br /> Nature of Error <br /> Corrected Base Fee/Chemical Count <br /> Amount Overcharged <br /> i <br /> Amount Undercharged <br /> Comments <br />