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�& 0 <br />ENVIRONMENTAL HEALTH DIVISION <br />ACCOUNTING WORKSHEET <br />UNIT # <br />CON[PUTER/PERMIT # /I/�r I <br />SriUS/FACILITY ADDRESS: 3 Z© <br />DBA: <br />BILL TO: 5cm r o PHo1NE: s zy- 9653 <br />BILLING ADDRESS: <br />CITYISTATE: I 1M 1 Od[ g 'V `moi ZIP: <br />PROGRAM: Zs� TYPE OF SERVICE: _ Q�/vjpt) qj_ QA <br />i <br />THE NAMMUM ME FOR E4CH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL. INSPECTION TPifE IS CO;,LPUT�-_D TO 7HE <br />NEAREST HAL? (1/2) HOUR, INCLUDING TRAVEL TIME. dl�} <br />i, rc ec: . <br />DATE <br />u( <br />SERVICE <br />WEEKDAY <br />SAM- <br />4:30PNI <br />WEFK14IGH7 <br />4:30P:.M-SeVvil <br />WEEKENDS <br />HOLIDAYS <br />DESCRIPTION OF WORTS <br />NAME <br />-H:r <br />4s-Rz <br />3o-Ia'od� <br />PIGS cit w <br />�e nnnr��r ca Ll r <br />�f�T <br />5; -,21 <br />J•a',Oa <br />Q/!/Vw AJ W/r <br />I cit <br />TOTALS <br />RAL\NCE DUE: <br />BILLING DATE: <br />EH 23 074 (Rev 3/22/91) <br />Nl <br />