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APPENDIX B <br /> SAMPLE INVOICE <br /> Q - <br /> w <br /> s <br /> STATE OF WASHINGTON <br /> DEPARTMENT OF ECOLOGY <br /> PO Box 47600• Olympia, WA 98504-7600 •360-407-6000 <br /> 711 for Washington Relay Service•Persons with a speech disability can call 877-833-6341 <br /> INVOICE <br /> Date <br /> COMPANY <br /> NAME <br /> ADDRESS Agreement No. <br /> CITY, STATE ZIP Invoice No.: <br /> Invoice for Ecology Cost Reimbursement Agreement Project No through (Date) <br /> Cost to Less Previous Current Invoice <br /> Date Invoices Amount <br /> Salaries 0.00 0.00 0.00 <br /> Benefits 0.00 0.00 0.00 <br /> Indirect 0.00 0.00 0.00 <br /> Contracts 0.00 0.00 0.00 <br /> Goods & Services 0.00 0.00 0.00 <br /> Travel 0.00 0.00 0.00 <br /> Staff Replacement 0.00 0.00 0.00 <br /> TOTAL <br /> Please remit payment and a cony of this invoice by (Date)to: <br /> Department of Ecology <br /> Cashiering Unit <br /> PO Box 47611 <br /> Olympia,WA 98504-7611 <br /> If you have any questions or desire further information regarding the agreement contact(Project Manager) <br /> at(phone).If questions are regarding the billing please contact (Fiscal Contact) in Receivables at <br /> Washington State Department of Ecology <br /> Cost-Reimbursement Agreement(CRA) Page 15 of 16 <br />