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PUBLl(1_ HEALTH SERVICES 'ap44!N <br /> SAN JOAQUIN COUNW — ?� <br /> JOG[KHANNA M.D.,M.P.H. "t <br /> Health Officer <br /> P.O. Box 2009 (1601 East Hazelton Avenue) • Stockton,California 95201 c Fow ' <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION - UNIT III <br /> BILLING STATEMENT <br /> (2099)),468-3427 <br /> FACILITY ADDRESS: 7a�� UO. A&e_-, Rey, <br /> —SWEEPS # . <br /> BILL TO: /' I S 10 <br /> BILLING ADDRESS: P.P. D. �dX Dglp �p <br /> CITY/STATE. I/ I ZIP: <br /> PROGRAM: z( J / o� 3, S�n 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 WEE IGHT 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 /> '�0- :� , <br /> to',Do- (0145ill;r [t-�C <br /> �- I1-42- <br /> ,r <br /> 15-3;3 c <br /> TOTALS <br /> BALANCE DUE: PAYMENT IS TO BE RECEIVED 30 DAYS FROM THE BILLING DATE. <br /> PENALTIES WILL 19E 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 />