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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # _ <br /> COMPUTER/PERMIT # lAo94 H 17 1Y 13 <br /> SITUS/FACILITY�JADD/RE-/S-S:_ A S+ <br /> DBA: <br /> BILL TO: S Fl (�ir o PHONE: 6ae0:5,R <br /> BILLING ADDRESS: (�q 63 1 W i <br /> CITY/STATE: I d'l� (I f� U -�^/ • . n ZIP: <br /> PROGRAM: TYPE OF SERVICE: I IJ�LWL� cS-CUc Q_ <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 SAM- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> /0:00 -11:06 1 ('Q V <br /> —/1; 3a lrccc /uta d �`e/ i` <br /> d5 k,t . -rAlvv R oF,14pVXz_ T— <br /> 1 °� 7i lfjaw—Z�o a cGi ,�w 4 UP <br /> I <br /> I <br /> TOTALS 5 <br /> BAL,kNCE DUE: /, o? /A. e-) 53 <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />