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PUBLIC HEALTH SERVICES <br /> P�UtN <br /> SAN JOAQUIN COUNTY i <br /> JOGI KHANNA M.D.,M.P.H. <br /> Health Officer <br /> C9G%F pR N\P <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 /> (22099)) 468-3427 <br /> FACILITY ADDRESS: 1717 ..C. (�/�4if�.(�J 57/t �G_2� SWEEPS #a3 7I <br /> BILL TO: y A S/ <br /> BILLING ADDRESS: <br /> CITY/STATE: /CQ/! ZIP: a'- <br /> PROGRAM: U S�T ���J BILLING DATE: <br /> THE MINIMUM 1754E 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 /> / S79.50/HR <br /> OF <br /> TOTALS <br /> BALANCE DUE. %��p i D(7 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 County Health Care Services <br />