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UBLIc� HEALTH SERVICES o�auPN <br /> SAN JOAQUIN COUNTY r.. <br /> f :Z <br /> JOGI KHANNA M.D.,M.P.H. - <br /> p� fJ Health Officer <br /> 0 �S f F.O. Box 2009 (1601 East Hazelton Avenue) Stockton, California 952.01 <br /> yf�/ (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION - UNIT III <br /> BILLING STATEMENT <br /> (209) 468-3427 j' h <br /> %ls i•+v7- &/A/,Il Al J1l G/-1' <br /> FACILITY ADDRESS: =w,-z- G /- [moo AAA-L- l,4a //0 t�J SWEEPS # <br /> 0¢ <br /> BILL TO: — <br /> BILLING ADDRESS: { — +� '9 3 15- <br /> • • T <br /> r- <br /> CITY/STATE: _ / J r� �2 L ZIP: <br /> PROGRAM: 1 U1 T BILLING DATE: <br /> 1111A- <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE TOTAL WEEKDAY WEEKNIGHT CONSUL- DESCRIPTION REHS <br /> of HOURS 8AM-5PM 5PM-8AM/ TATION at of WORK SIGNATURE <br /> SERVICE WORKED $53.00/HR WEEKEND/ S53.00/HOUR <br /> HOLIDAYS <br /> S79..50/HR <br /> Ly <br /> 4 II" <br /> r\ G/ <br /> V4 A <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 /> Avision of Sar,Joaquin County Health Care Services <br /> � s <br /> s <br />