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i <br /> PURL HEALTH SERv CES <br /> SAN JOAQUIN COUNTY r: <br /> JOG[KHANNA&f.D.,4I.P.H. <br /> Health Officer <br /> P.O. Box 2009 . (1601 Easc Hazelcon Avenue) - Scockron,California 95201 a�lp•R�,` <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION - UNIT III <br /> BILLING STATEMENT <br /> (209) 468-3427 <br /> FACILITY ADDRESS: __ �(e� (�bl A-- —SWEEPS # l�t� <br /> BILL TO: ,0 2 . <br /> BILLING ADDRESS: 1 Y <br /> CITY/STATE' ---��AC� f ll�rTp G, —_ _ _ ZIP: ? - <br /> PROGRAM: BILLING PACE: <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIOINSPECITON,�'I'IME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR„ INCLUDING TRAVEL TIME. y <br /> �J <br /> z-- <br /> DATE TOTAL WEEKDAY WEEKNIGHT ,CONSUL- DESCRIFU REH , <br /> of HOURS SAM-5PM 5PM-8A.Wi TATION at of WO SIGMA RE 1 <br /> SERVICE WORKED S53.00/HR WEEKEN S53.00/HOUR - <br /> HOLID 'YS <br /> S79.5R <br /> ! �4 t U EY Ctu.c+.+tt fStCiLy <br /> fl' owNd2:a � w. b+wre. <br /> ? <br /> "0 <br /> TOT <br /> BAIATu +CE DUE: PAYMENT IS TO BE RECEIVED 30 DA,_S M04 IE 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 /> v 6a <br /> EH 23 074 (Rev 1/14/91) 4: P:(5- r: c s f <br /> A Division of San Joaquin Counry Health Care Services + <br /> r` <br />