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OFFICE OF E:I ERGENCY SERVICES <br /> HAZARDOUS MATERIAL MANAGE\MNT PLAN FEE <br /> CURRENT YEAR -1 (0 <br /> BILLING CORRECTION RECORD <br /> Name of Business--L M =v-t C <br /> Primary Contact 31--VA Account No. <br /> Facility Mailing Addres wlZ <br /> Billing Year That Error Was Made <br /> Amount Originally Invoiced , <br /> nn®Q <br /> Original Base Fee/Chernical;Count V <br /> Type of Error: [ ] Data Entry (YReview [ ] Other <br /> Nature of Error C0M F i- J el� U'1A-Q— Lo-�L-� <br /> Corrected Base Fee/Chemical Count 7 G o f 7 <br /> Amount Overcharged 1 o <br /> Amount Undercharged 1 <br /> Commens <br /> t ._ / �0- 1 R 1' 6 / �� 00c.Ll� <br /> For Supervisor's Use: Supervisor's Approval <br /> Actions Taken or Ordered v a�, /9�s' <br />