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r*. <br /> PUBLIt HEALTH SERVICES oAQU.N <br /> SAN JOAQUIN COUNTY <br /> JOGI KHANNA M.D.,M.P.H. y` , ^ 4 <br /> Health Officer <br /> P.O. Box 2009 • (1501 East Hazelron Avenue) - Stockton,California 95201 6i6 <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION - UNIT III <br /> BILLING STATEMENT <br /> (209) 468-3427 <br /> FACILITY ADDRESS: a aD 7 ! �OYt !�J SWEEPS D dZ' <br /> BILL TO: dl e b -- -- - <br /> BILLING ADDRESS: <br /> CITY/STATE: t_ G ZIP: <br /> PROGRAM: C2,S - - -BILLING DATE: <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 WORLD S53.00/HR WEEKEND/ S53.00/HOUR <br /> C ?04- ` HOLIDAYS <br /> j $79.50/1-IR <br /> .7' -3:16 <br /> Q <br /> -�` /e. <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 � ' <br />