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PUBLIC-.HEALTH SERVrCES qp <br /> SANJOAQUINCOUNTY- JOGI KHANNA M.D.,H.P.H.Healch OfficerP.O. Box 2009 • (1601 Easc Hazelcon Avenue) • Scockcon,California 95201 <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION - UNIT III ���� G P460 E It <br /> BILLING STATEMENT <br /> (209) 468-3427 <br /> FACILITY ADDRESS: //S' 3 //�. c% Lu. �� C'i c /e SWEEPS # <br /> BILL TO:BILLING <br /> c-- <br /> BILLING ADDRESS: <br /> 4 S33L <br /> CITY/STATE: — �_. - �%7 " `w ZIP: <br /> PROGRAM: G/� �i�yctrf2� r*� f� BILLING DATE: <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECITON 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-SAM( TATION at of WORK SIGNATURE <br /> SERVICE WORKED S53.00/HR WEEKEND/ S53.00/HOUR <br /> HOLIDAYS <br /> S79.50/HR <br /> ^10"7y <br /> "719l =L <br /> FV /ay view <br /> TOTALS <br /> BALINCE DUE. i f1 _) 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 Div: '-n of San Joaquin Counry Health Care Services <br /> Y <br />