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1 i <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 2 ACCOUNTING WORKSHEET <br /> UNIT # J <br /> COMPUTER/PERMIT # q�G��� L <br /> SITUS/FACILITY ADDRESS: /X / �� ���yN S�6 " ZV^ J'T <br /> DBA: TDy�-� 7�y Y U IZ LI'Zck <br /> BILL TO: 5606,9 PHONE: <br /> BILLING ADDRESS: �Z31 Kn <br /> CITY/STATE: Nl od PS - ZIP: <br /> / p I <br /> PROGRAM: ���S TYPE OF SERVICE: f I N IAC IJ iGGJ ✓e w Vfll� <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 /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 8AM- 4:30PM-SAM/ <br /> SERpVICE 4:30PM WEEKENDS / <br /> ID-0-9 i0O- d'Oo �M v GJ�� <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />