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PUBLI T ! , . H SERI CES ^4u ~•pp <br /> SAN JOA(UIN COUNTY <br /> vri�& <br /> JOGI KHANNA bI D,AP-H. / <br /> aEaith Officer <br /> P.O. Box 2�G9 (Iti%I er_•t Hazelton Avence) • Sc,x4:c•n.CalifOzcia %1201 <br /> (2091) 468.3400 <br /> ENVIRONMENTAL HEALTH DIVISION • UNIT III <br /> BILLING STATEMENT <br /> (209) 468.3427 <br /> FACILIT'.' ADDRESS:_ `tLIZb- W kET��f—�yM,pSWEEPS <br /> BILL TO; s�� <br /> BILLING ADDRESS: 37 <br /> ZIP <br /> ZIP: <br /> CITYISTATE: G <br /> PROGRAM: BILLING DATE: — <br /> THE MINIMUM -LME FOR EACH INSPECTf0I4 IS ONE (1) HOUR, A14Y ADDIT'IONAl %NSPECTION TIME IS COMPUTED TO THE <br /> p1EAR£ST I•IAIF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> OTAL WEEKDAYTWFEKINIGHT CONSUL- DESCRIPTION REHS <br /> IFRr <br /> HOURS 8AM-5PM SPM-8AM/ TATION at of WORK SIGNATURE <br /> VICE WORKED iHR WEEKEND/ S53.001HOUR <br /> HOLIDAYS <br /> S79.50/HR ^�-� ��_� y:oo— 1 <br /> 7✓ .0 I j�/�p� <br /> L 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 /> PFTURN ONE (7) COPY OF THIS BILL ALONG WITH PAYMENT. MAKE CHECKS PAYABLE TO: <br /> PUBLIC HEALTH SERViCES-ENVIRONNIENTAL HFALTH DIVISION (PHS.EIID). <br /> EH 23 074 (Rev 1/14/91) <br /> w;sion of San JwgQin Co,:n,y Healer C'a Srr+ices <br />