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0 0 <br /> 3AN JO!411.11N 1.0i'Pil- I lEAl TL 1 1',11-TI <br /> ENVTl-'0NHFNTAl- HFOLTH 1*,,'kT(.W) I <br /> 1601. E.. HAZEI_TON W)FOHE <br /> STOCKTON, CAl.TFORfJlA <br /> (2 09) 466-678i <br /> RILL FOR Sl-':RVTC'E(S) LJSTFD BF! OW <br /> ADf.-RF..SS CITY ,TATE_..._...F <br /> 1.)B(',/Pl,,OPFRTY OWNER- <br /> BILL TO: NAME- <br /> ----------- <br /> PROGRAM:-S-i?--------------------- <br /> DESCRIPTION OF <br /> -------"='= -------------------------- <br /> DATE OF SFRVICE(S) TIME SPENT LOCATION <br /> ----------------- ---------- <br /> ---------------- ---------- ------------------------------------------------ <br /> --------------- ---------- ----------- ------------------------------- <br /> TOTAL TIME -------------- ca --------- PER HOUR BAt.ANcF DLIF <br /> BILLING DATE_-___-____-._ PAYMENT MUST BE RECEIVED BY-__.____.__.....__.____ <br /> c; tv <br /> RETURN ONE COPY OF THIS BILL ALONG WITH PAYMENT. MAKE Cu"(,MYAl3l-F TO THE <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT. t1�� v.4 Nyb I <br /> ftootAN014 �Awv <br />