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BILLING RECO -upRD FORM <br /> DBA: 41) lye / <br /> SITUS ADDRESS : 3/ 33 14✓ ///L T /6 <br /> PROGRAM: 04, SWEEPS# : Z3 � <br /> COMP . # : l)",7- / <br /> BILL T0: <br /> NAME: /-}D 92 T <br /> ADDRESS : & <br /> : - <br /> TITLE OF SUBMITTAL <br /> OR DESCRIPTION OF SERVICE: ASO/L SquPL/�/G <br /> *DATE RECEIVED: *DATE OF SUBMITTAL: <br /> ** <br /> INIT'L CK#/ ADD'L CK#/ TOTAL HRS (use 1/4hr increments ) SANITTAARIAN <br /> DATE FEE PD CASH FEES CASH OR <br /> CLERK <br /> PD. WEEKDAYS WEEKNIGHTS WEEKEND/ <br /> HOLIDAYS <br /> �] /-fiteGGN 1paLL <br /> TOTAL $ S HRS HRS HRS <br /> @ $35/HR @ 52 . HR @ S70/HR Total <br /> Charges <br /> TOTAL $ 35�; $ $ Less <br /> CREDIT $ Credits <br /> DATE BILLING SUBMITTED: G�G��1 BY : ALANCE DUE Sge� <br /> * Use for sit( ssessment proposa s , wor -ills , e C. <br /> **Include travel time for field services <br />