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PUBLIk-,'�' HEALTH SEAICES <br /> SAN JOAQUIN COUNTY ©? <br /> � A <br /> JOGF KHANNA KD.,W.P.H. 'T { :< <br /> Hea[ch Officer <br /> P.O. Box 2009 . (1601 Easc Hazelton Avenue) • Scockron California 9520I <br /> (209) 468-3400 <br /> ENVIRON\[ENTAL HEALTH DIVISION - UNIT III <br /> BILLING STATEMENT <br /> (209) 463-3427 <br /> FACILITY ADDRESS: 77 .5�- CJ?C ,,,/ SWEEPS #_ Q <br /> BILL TO: rP <br /> BILLING ADDRESS: , D- eox <br /> CITY/STATE; ., f't,r,''�eas ✓`� ZIP: �S� y <br /> PROGRAM: BILLING DATE: <br /> THE IMINWUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDLNG TRAvEL TIME. <br /> DATE TOTAL WEEKDAY WEEKNIGHT CONSUL- DESCRIPTION RENS <br /> of - HOURS 8ANI-5PM 5PM-8AM/ TATION at of WORK SIGNATURE <br /> SERVICE WORKED S53.00/HR WEEKEND/ S53.00/HOUR <br /> HOLIDAYS <br /> / c3 S79.50/HR <br /> =TOTAL,S <br /> BA"NCE DUE: PAYIYIENT 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 Dig inion of San Joaquin County Heslch Care Cervices <br />