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PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY Q <br /> i1 <br /> JOCI KHANNA M.D.,M.P.H. y_ <br /> Health Officer �. 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 /> (209) 468-3427 <br /> FACILITY ADDRESS: AW 1`1r4+QA'*f- SWEEPS # Z7! <br /> BILL TO: Pa K( I.At-f ddekr—A SDM S <br /> BILLING ADDRESS: RO. 43Dx65, /ZI jr. .S-MaF T <br /> CITY/STATE: LriA-r6( _Fo�Pp GA- Ti R'6 ZIP: <br /> PROGRAM: (/6 `T— 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 5PM-8AM/ TATION at of WORK SIGNATURE <br /> SERVICE WORKED S53.00/HR WEEKEND/ S53.00/HOUR <br /> HOLIDAYS <br /> S79.50/HR <br /> Gf0S1>ee. ro lom <br /> a//t felt rG v e-4 . <br /> zI 13 q Ifj sfaswf_k w <br /> Ake <br /> LJJI remav .V <br /> is I V <br /> TOTALS <br /> BALANCE DUE: PAYMENT IS TO BE RECEIVED 30 DAYS FROM TIIE 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 /> iision of San Joaquin County Health Care Services <br />