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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT# <br /> COMPUTER/PERMIT # 12- Su oS /oY/ <br /> SITUS/FACILq.I.T,YADDRESS: lel S. (7o.�17a�St Seo . rm <br /> DBA: D.I/ �a <br /> d lAUA • <br /> BILL TO: -sII �., . �Ii I/J/jx- . � PHONE: 673(a- oa D3 <br /> BILLING ADDRESS: J;23;L, <br /> CITY/STATE: , I 06` n ZIP: 3a <br /> PROGRAM: l r-T6'I— TYPE OF SERVICE: ODES//n0 eq I )(s <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 8AM- 4:30PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> 06S ale Ram r-w Ka <br /> 5//5 R► Q 8yoo Onc rnolys4yy 10 & <br /> avri fay <br /> 51/S 9/ 3:�0' n r, rryi ov�Q Ir ),S/At <br /> I /NIQ, <br /> TOTALS <br /> BALANCE DUE: / <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />