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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/P.ERMIT # _/� �� p <br /> SITUS/FACILITY ADDRESS: z� <br /> //•• <br /> DBA: l� 7 <br /> BILL TO: � l GlC SGS ' r PHONE:( -7)?.3/-/?a <br /> BILLING ADDRESS: f� 0, ig-dx l d & <br /> CITY/STATE: // r ZIP: F<1 2 7 7 <br /> PROGRAM: ZI C Sl TYPE OF SERVICE: _ C 6O Sa . c5?/eriTHE 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 NAbIE <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 430P:yi WEEKENDS <br /> pol <br /> TOTALS <br /> VALANCE DUE: <br /> BILLING DATE:- <br /> EH <br /> ATE:EH 23 074 (Rev 3/91) <br />