Laserfiche WebLink
ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # ff— ��pp / <br /> COMPUTER/PERMIT # C�,4SH61y 3 6-6 1 <br /> SITUS/FACILITY ADDRESS: Z q 17 ! A)- /7 l p; n--- <br /> DBA: -J&� &ofS LYS <br /> BILL TO: '—st ,��j�� c C) /, PHONE: <br /> BILLING ADDRESS: / � / 0. Ya- e k-) IqWJ' <br /> CITYISTATE: C& c t9q ZIP: <br /> PROGRAM: TYPE OF SERVICE: &4LdYG� <br /> THE MINIMUM TIME OR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INbiECTIOrW TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> Lc> - <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 8AM- 4:30PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> 5- 9� ,o: 1 0.30 x;024 :1 <br /> 2 Ile <br /> ct_oo-lo:00 oan io J / <br /> C. <br /> O� t. <br /> !�- qo1 t:Do-3feo re v v sc <br /> '30 �Ge n¢may, su .71�h <br /> BALANCE DUE: <br /> BILLING DATE: /%� /�j®j//l�//9�/� b�/� ✓`�� �j <br /> EH 23 074 (Rev 3/22/91) <br />