Laserfiche WebLink
G RECORD FORM RECEIVED <br /> JANu1991 <br /> .TUS ADDRESS : } NVIRONMENIAL HEALTH <br /> SWEEPS# : <br /> COMP . # : d / <br /> PROGRAM: <br /> BILL TO: <br /> NAME: O Cu ZIP : <br /> ADDRESS : STATE:«-- <br /> CITY : <br /> TITLE OF SUBMITTAL S7�C�1'l/�71,j <br /> OR DESCRIPTION OF SERVICE: <br /> *DATE RECEIVED: <br /> INIT'L CK#/ ADD' CK#/ TOTAL HRS (use 1/9hr increments ) OR <br /> FEES <br /> WEEKNIGHTS WEEKEND/ SANITARIAN <br /> KIA <br /> DATE FEE PD CASH PES CASH WEEKDAYS HOLIDAYS <br /> C <br /> l✓r, p <br /> /o-Ioy'o � <br /> /o-h-90 <br /> I 6-k4c) tcQ�u <br /> 9 /ow, <br /> to r <br /> slt / <br /> N- <br /> 10 to ea c� <br /> lr a1-y0 — �l2 <br /> i <br /> 13040 �. />�� <br /> r I4 v <br /> ,�-3-90 /x, Q S > TiZ <br /> / 0 <br /> -y-70HRS HRS HRS <br /> 5 / g <br /> TOTAL 5 ! Tota k3 <br /> @ $35/HR @ 52 . 50/HR @ 570/HR Char J <br /> �(J $ Less <br /> TOTAL $ 4 �� Credit <br /> CREDIT $ <br /> � BY . BALANCE DUE $ <br /> DATE BILLING SU .TTED: <br />