Laserfiche WebLink
DBA — /�i�i0� P• <br /> SITUS ADDRESS : <br /> s <br /> PROGRAM: /lei <br /> SWEEPS# : V/ so/ <br /> BILL TO: COMP• # : _ /�.�g� <br /> NAME: S //9CO <br /> ADDRESS :_ <br /> CITY• /9a /PsFz� STATE: C,4 <br /> — 2ip :�/ <br /> TITLE OF SUBMITTAL <br /> OR DESCRIPTION OF SERVICE: <br /> *DATE RECEIVED: *DATE OF SUBMITTAL : <br /> INIT'L CK#/ ADD 'L CK#/ TOTAL HRS ( use 1/4hr increment$*) SANITARIAN <br /> DATE FEE PD CASH FEES CASH <br /> OR <br /> PD. WEEKDAYS WEEKNIGHTS WEEKEND/ CLERK <br /> HOLIDAYS <br /> TOTAL $ $ HRS HRS HRS <br /> @ $3,5/HR 52 . 50/HR @ $70/HR Total <br /> TOTAL Charges <br /> CREDIT $ <br /> $ $ $ Less <br /> Credits J <br /> DATE BILLING SUBMITTED: BY : BALANCE DUE <br /> $�CK) <br /> * Use for site assessment <br /> proposals , wor p ans, etc. <br /> **Include travel 0me for field services • <br />