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PUBLIC HEALTH SERA ICES <br /> SAN JOAQUIN COUNTY <br /> JOGI KHANNA M.D.,M.P.H. °: 1 `< <br /> Health Officer <br /> Cq `P <br /> P.O.Box 2009 . (1601 East Hazelton Avenue) . Stockton,California 95201 c'Fap ' <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION - UNIT III <br /> BILLING STATEMENT <br /> (209) 468-3427 <br /> FACILITY ADDRESS: '-W l J SWEEPS # zM6 <br /> BILL TO: Wesl.j Mpa p <br /> BILLING ADDRESS: 1551 E F",G t A/, <br /> CITY/STATE: 14:104; CA ZIP: '1S Z yo <br /> PROGRAM: Wg-ST 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 SPM-8AM/ TATION at of WORK SIGNATURE <br /> SERVICE WORKED S53.00/HR WEEKEND/ S53.00/HOUR <br /> HOLIDAYS <br /> $79.50/HR <br /> S / <br /> S 9 45 <br /> J v <br /> 11 <br /> TOTALS 3 q <br /> Ze <br /> BALANCE DUE: PAYMENT IS TO BE RECEIVED 30 DAYS FROM THE BILLING DATE. <br /> PENALTIES WILL Ert 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 />