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PUBLIC HEALTH SERVICES <br /> pP�u'�N <br /> \ <br /> SAN JOAQUIN COUNTY <br /> N: < <br /> JOGI KHANNA MD.,M.P.H. - <br /> Health Officer <br /> \\. P.O. Box 2009 - (1601 East Hazelton Avenue) . Stockton, California 95201 <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION - UNIT III <br /> BILLING STATEMENT <br /> I (209) 468-3427 / <br /> FACILITY ADDRESS: l d�J eoo /V . � ✓ �� SWEEPS # �D.3lo <br /> BILL TO: s t al r0 1io -J <br /> BILLING ADDRESS: ^t //7- / `�,e � /— / /CL ��� �, -f� C G <br /> CITY/STATE: zX , /C1 s-k, , C14 9 5 5 S / ZIP: <br /> PROGRAM: Co BILLING DATE: <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE TOTAL WEEKDAY WEEKNIGHT CONSUL- DESCRIPTION REHS <br /> of HOURS 8AM-5PM 5PM-8AM/ TATION at of WORK SIGNATURE <br /> SERVICE WORKED S53.00/HR WEEKEND/ S53.00/HOUR <br /> HOLIDAYS <br /> 579.50/1-IR <br /> Gk, Xr�izi`w <br /> 3-(0 -Cil '/ v <br /> s;Ys - 3U <br /> �o <br /> TOTALS <br /> BALANCE DUE: PAYMENT IS TO BE RECEIVED 30 DAYS FROM THE BILLING DATE. <br /> PENALTIES WILL BE APPLIED TO PAST DUE ACCOUNTS 30 DAYS FROM BILLING DATE. <br /> RETURN ONE (1) COPY OF THIS BILL ALONG WITH PAYMENT. MAKE CHECKS PAYABLE TO: <br /> PUBLIC HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION (PHS-EHD). <br /> EH 23 074 (Rev 1/14/91) <br /> A Division of San Joaquin Counry Health Care Services <br />