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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> WIT # � �/J, nn � 1 <br /> COMPUTER/PER.MIT # L,'7S/ ! O ca 3 oa5�/�p / <br /> SII['S/FACILITYADDRESS P7" <br /> DBA: --to e. s oss .. (r/�&_ Axl l . <br /> BILL TO: Tar )e1J 1/G�J , cjYj G. PHONE��bt7�4'V-0-17 <br /> BILLING ADDRESS: /am--11339 S Y a c,QF.��yt�` Rd l <br /> L <br /> CITY/STATE: // 'J (f/lq y ZIP: <br /> �(. <br /> PROGRAM: UISS TYPE OF SERVICE: /102114 <br /> THE MIMMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUT'eD TO THE <br /> NEA.RE ST FLti (1/2) HOUR, INCLUDING T?AVEL TIME. <br /> O 0 0 <br /> DATE WEEKDAY WEE, GHT HOLIDAYS DESCRIPTION OF WORK RENS NAME <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 4:o PMe<ENDS <br /> a� I � — �� `' � ( �- 7 - �' I <br /> Ip-Qcc�L.- <br /> 9roo' rf'30 eeiVL <br /> o-3130 I PetriQcJ <br /> e;a6) <br /> TOTALS <br /> MALUNCE DUE: <br /> MILLING DATE ` <br /> EH 23 074 (Rev 3/22/91) <br />