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PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY r.' <br /> JOGI KHANNA M.D.,M.P.H. . . <br /> Health Officer <br /> P.O. Box 2009 • (1601 East Hazelton Avenue) • Stockton,California 95201 <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION - UNIT III n <br /> BILLING STATEMENT <br /> (209) 468-3427 <br /> FACILITY ADDRESS: El 12 .Z, I,�r S-fo 1G SWEEPS # <br /> BILL TO: Se VAC_0 <br /> BILLING ADDRESS: -1131 N- <br /> CITY/STATE: es+& CA ZIP: �3 51 <br /> PROGRAM: UGST BILLING DATE5/2319( <br /> THE WNLNWM 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 SAM-5PM 5PM-8AM/ TATION at of WORK SIGNATURE <br /> SERVICE WORKED S53.00/1-IR WEEKEND/ S53.00/HOUR <br /> HOLIDAYS <br /> S79.50/HR <br /> siz3 �l � <br /> TOTALS <br /> BALANCE DUE 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 Counry Health Care Services <br />