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Attachment D <br /> FINANCIAL INVOICE <br /> FOR <br /> HAZARDOUS MATERIALS HAZARDS ANALYSIS UPDATE <br /> RECIPIENT : AGREEMENT # <br /> COST CLASSIFICATIONS <br /> AMOUNT AMOUNT <br /> APPROVED <br /> REQUESTED BY THE <br /> BY THE RECIPIENT DEPARTMENT <br /> 1 . Contact and Sample ( 15% Max. ) $ $ <br /> 2 . Hazards Analyses ( 30 % Max. ) $ $ <br /> (50% completed/submitted ) <br /> 3 . Hazards Analyses (30% Max. ) $ $ <br /> (50% completed/submitted ) <br /> 4 . Final Work Product Completed (25 % ) $ $ <br /> TOTAL AMOUNT $ $ <br /> (To be completed by <br /> the Department) <br /> I certify that to the best of my knowledge and belief the billed costs are in accordance with the <br /> terms of the Agreement. <br /> Signature of Authorized Official/Title Date <br /> TOTAL AMOUNT TO BE PAID AS OF <br /> THIS INVOICE $ <br /> AUTHORIZED BY <br /> ( To be completed by the Department <br /> 19 <br />