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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # 11.1— D <br /> COMPUTER/PERMIT # RAwa/iD!D <br /> SITUS/FACILITY ADDRESS: <br /> LI <br /> DBA: / \a.,0 <br /> BILL TO: ��'jPHONE-Al 9)Y6,;?jejPJ <br /> BILLING ADDRESS: / D./ A9:CTX —7 3 J / <br /> CITY/STATE: C 14 ZIP: <br /> PROGRAM: a3• CD TYPE OF SERVICE: T/o/Yl Ef'J L'ilJ)c� Gli <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 /> /5 a,— / <br /> DATE <br /> a, - <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> "-aa-9a <br /> 1 :30 - a .3 q- <br /> TOTALS _ , W , <br /> BALANCE DUE: or <br /> BIL.LIN ATE <br /> • <br /> EH 23 074 (Rev 3/22/91) <br />