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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # JV- _ / <br /> COMPUTER/PE-RMIT # A� �lqr 3 / /oZ 3 <br /> SITUS/FACILITY ADDRESS: c3/ ( <br /> DBA: A0 RET Tn c . <br /> BILL TO: Ad 14IqT .1�4C, PHONE: <br /> BILLING ADDRESS: <br /> � ZIP:: <br /> PROGRAM: TYPE OF SERVICE: bi! <br /> !Gy/LJ <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL. INSPECTION TIME IS C QPUTEO TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 3AIvl- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> TOTALS p <br /> BALANCE DUE: d �! <br /> MILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br /> v <br />