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PUBLI ` HEALTH SEACES P�uIv C <br /> ,O <br /> SAN JOAQUIN COUNTY <br /> N: t ^ < <br /> JOGI KHANNA H.D.,M.P.H. , =_ <br /> Health Officer c4 <br /> P.O. Box 2009 (1601 East Hazelron Avenue) • Stockton, California 95201 Ao a1' v <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION - UNIT III <br /> BILLING STATEMENT <br /> (209) 468-3427 /' y 2 <br /> FACILITY ADDRESS: 0?YA /L 666 /aq (,( SWEEPS # -3e5 <br /> BILL TO: <br /> <br /> <br /> <br /> PROGRAM: / 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 WORKED S53.00/HR WEEKEND/ S53.00/HOUR <br /> HOLIDAYS <br /> S7950/HR <br /> ;,. <br /> 3 a6-41 % y kh c�QQ <br /> / q / <br /> 1y-ll� �l Y 5;3o-/d;oo <,J 1,0_eLL A <br /> Q <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 CRev 1/14/91) <br /> A Division of San Joaquin County Health Care Services <br />