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PUBLIC; HEALTH SER)ICES �OP�VIN•.0 <br /> SAN JOAQUIN COUNTY Z <br /> JOGI KHANNA M.D.,M.P.H. <br /> Heahh Officer <br /> P.O.Box 2009 • (1601 Easc Hazelton Avenue) • Srockron,California 95201 �iFed� <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION - UNIT III <br /> BILLING STATEMENT <br /> (209) 468-3427 <br /> FACILITY ADDRESS: l�>ls /V/ p'�L7�Cl/�Y SWEEPS # SZ 7 <br /> BILL TO: <br /> BILLING ADDRESS: <br /> CITY/STATE: ZIP: <br /> PROGRAM: BILLING DATE: <br /> THE MINIMUM TALE FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR,INCLUDING TRAVEL MM. <br /> DATE TOTAL WEEKDAY WEEKNIGHT CONSUL- DESCRIPTION $EHS <br /> of HOURS 8AM-5PM 5PM-8AM/ TATION at of WORK SIGNATURE <br /> SERVICE WORKED S53.00/HR WEEKEND/ S53.00/HOUR <br /> HOLIDAYS <br /> S79.50/HR <br /> l: u� <br /> 3 -5- : <br /> TOTALS <br /> BALANCE DUE- PAYMENT IS TO BE RECEIVED 30 DAYS FROM THE 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 /> EH 23 074 (Rev 1/14/91) <br /> A Division of San Joaquin County Health Care Services ro <br />