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• 0 - 6 <br /> JAN JOAQUIN LOCM_ HEALTH DISTRI'Cl <br /> ENVTRONMENTAL HEALTH DIVT.STON <br /> 1601 E. HAZF_I_TON AVFNUE <br /> STOCKION, CAI_TFORNIA <br /> (209) 466-6781'1. <br /> RILL FOR SERVTCF-(S) LTSTFD RF! OW <br /> ADDRESS Tok1C' Iib---- i;TTY----- ----`iTATF--Cck --- .<?f'----- <br /> -DOWPROPFP.TY OWNEP.---eA��� ----------- ----------- --- ------ --- ----- <br /> BILL TO: NAME <br /> ADDRESS------------------- -- - -- <br /> CITY/STATE-------------(----------1--``------------7_TP------ <br /> PROGRAM:__!� _ <br /> DESCRIPTION OF SERVICE(S) :_ F ___� � <br /> DATE OF SERVICES) TIME SPENT LOCATION <br /> 4-3 -- <br /> --------------- ---------- ------------_------------------------------ <br /> TOTAL TIME _��SL _ @ PER HOUR =s_2! _`BALANCE DLC-. <br /> BILLING DATE �� PRYMENT MUST RE RECF_IVF.D BY__v��_"r <br /> RETURN ONE COPY OF THIS BILL Al.-ONG WITH PAYMENT. MAKE CHECKS PAYABLF TO THE <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT. <br />