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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING `VORKSHEET <br /> UNIT #;:Irl <br /> Co"VIPUTER/PERmIT # /0/?CyS ZZ 154V E64,5 1,31 <br /> SITUS/FACILITY ADDRESS: gz� S• C-��CiQO F . 0 G0,�>2 <br /> DBA: 14,4'l - PSI / / <br /> BILL TO: Br�P-�f/f�(/�i C6'NSUG-7"IA r i��FI�S Z/Z PHONE:( 4l6)L/,,,�l',124 <br /> BILLING ADDRESS: / '��- A 141134.-Al-4 yLI�L� <br /> CCI-YiSTATE: ZIP: <br /> PROCRA.M: //Sri TYPE OF SERVICE: ! T ��/G/f�C STiLGl�+�T/an/ �EhavriL <br /> THE MINIMUM T[ME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TME IS COMPUTED TO Tr <br /> NE?Z.ST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PNI-SA.VI/ <br /> SERVICE 4:30PM WEEKENDS <br /> 111z,o1,?o 1 ,04-Z] I <br /> /zy%. Ilga �yi7 I i/iEw4> //1-+4NS <br /> / �/� /D6Ql �� I Pu /E✓ FJ' 1rt5TMlMioJ I�/�SEY�i�E A/ -r <br /> •A udv� <br /> A <br /> �( /z-3o-y;3��� ?,dN/� iv�idL2�✓C�Ir� L <br /> 671 <br /> Zv y/ BcXkira-/P4ry I�NavEc�a�Fzo�i - �`. � NZ <br /> ��w I <br /> i4coEc! ETL v J <br /> y� ioN E.,� w v EgrL `i Z!i Rl vo- 9 �v A ef444 176;6-u <br /> TOTALS <br /> B.\L\NCE DUE: <br /> BILLING DATr <br /> 'cH 23 074 (Rev 3/22/91) <br /> v � <br />