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PUBLO.'.]. HEALTH �•O.U f ey <br /> SAN JOAQUIN COUNTY <br /> ){AGI KHANNA Nl.D.,XP.H. <br /> Healch Officer • c fP <br /> 't�IF�.Ra <br /> P.O. Box 2009 (1601 Easc Hazelcon Avenue) • Scockton,California 95201 <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION - UNIT III <br /> BILLING STATEMENT <br /> (209) 463-3427 <br /> FACILITY ADDRESS: �� „ �—c o <br /> SWEEPS •� �-S� <br /> BILL TO: <br /> BILLING ADDRESS: `�'3 e'/ <br /> ZIP: <br /> CITYISTATE: <br /> PROGRAM: , �is�r� > ir�� s7 ���'� l KILLING 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, INCLUDNG TRAVEL TIME. <br /> DATE -TOTAL WEEKDAY WEEKNIGHT CONSUL- DESCRIPTION RENS <br /> of HOURS 8A.Mi-5PM 5PM-3ANI/ TATION at of WORK SIGNATURE <br /> SERVICE WORKED S53.00/HR WEEK NDS 553.00/HOUR <br /> HOLIDS79.50/HR <br /> 7/ 1 r <br /> r/ A// <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-ENVIRONMiENTAL HEALTH DIVISION (PHS-EHD). <br /> EH 23 074 (Rev 1/14/91) <br /> rl Division of San Joaquin Councy Health Care Services <br />