Laserfiche WebLink
BILLINGRECORDFOR..M�� <br /> DBA: �� 1 <br /> SITUS ADDRESS :jF�2 (o 17). l � GC <br /> S{LkC'. r1q 9sa o 4 <br /> PROGRAM: I/I �S / SWEEPS# : 10 <br /> COMP . # <br /> BILL TO: /Gvvl /J S� <br /> NAME: <br /> ADDRESS : r <br /> CITY: T11tp Si! t,h STATE: <br /> TITLE OF SUBMITTAL <br /> OR DESCRIPTION OF SERVICE: <br /> *DATE RECEIVED: *DATV OF SUBMITTAL : <br /> * * <br /> INIT'Lr!ASH <br /> ADD'L CK#/ TOTAL HRS ( use 1/4hr increments ) SANITARIAN <br /> DATE FEE PD FEES CASH OR <br /> PD. WEEKDAYS WEEKNIGHTS WEEKEND/ Ci,ERK <br /> HOLIDAYS <br /> a5 a , <br /> c 0 R ,S! <br /> 5 <br /> A - <br /> TOTAL $ S HRS 11L HRS HRS <br /> @ $35/HR @ 52 . 50/HR @ $70/HR Tota 36_ $�)- <br /> Charges <br /> TOTAL $ <br /> CREDIT $ �S7 A $ � ` $ Less �J <br /> E _ Credits <br /> DATE BILLING SUBMITTED: BY: BALANCE DUE $ <br /> * Use for site assessment proposals , wor p ans , e c . <br /> **Include travel time for field services <br />