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FEE PAYMENT INFORMATION <br /> Use for consultations, reinsnections, chargeable complaint inIgggttions and/or administrative 1188ringS at INVENTOaIM <br /> FACILITIES: <br /> 1 Fill out Boxes 1 through 7. <br /> 2. Submit to ACCOUNTING OFFICE with'fee paid. <br /> 3. The ACCOUNTING OFFICE will receipt payment (Boxes 9 through 15), assign an INVOICE #(Box 8) and forward to <br /> the RENS staff persona <br /> 4. The assigned INVOICE # will be used with the facility's PROGRAM/WATER RECORD ID on daily activity record for <br /> activities to be charged against.this fee., <br /> FACILITY..'.? 1 (a,60 <br /> ... Fltcli tT3F'14C1tEtl:$S <br /> Ot6ldNATr"o 'Etodtl < S ltvlcE $r ;>' 1111r> �aF 11111dt�ICE <br /> R� #s:•• •::EL�MEN: <br /> >.:C <br /> oil ::SE <br /> ,..,:. ,v:4}i:ti:::i•iiT}:�:rv�4'•:'r..,... :�`vi'i::c:t:• .,. :::::•.:{•:$?.:{;:i;.:}�:;':::::::Liiy;.}:•$iii?i}S;<:ii:i:}:ik�;is i:::•'{ <br /> - <br /> :.. .:..::.Dl1fi ; ..:.:.:.:.:.:.:.:........:.....:.:.:.:.:.:......:...A . ...». . �NEQ :...........:..:.....:.:.:.:..:�.i.. .o....I...1..'.,..;.::.:..;:.;..:... ..:.:.:..::..:.:.......•...G. NEG`K:.:..:,.:.:.:: ::.::.....Ic:Vt <br /> PAYMENT ...;:AMU : . <br /> :..,.:.. <br /> 13 14 VI-N <br /> 71— 96 <br /> o r erg <br /> lC.......... ... 9U1!Vf8Ba0R.:•%.:•:::::•::;,.- :•::::::.•:::::: W14G .:;.,:•: :.;:. ,.:: ..... <br /> v <br /> ...:. ..... .:.. . <br />