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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT #:LT__ <br /> COMPUTER/PERMIT # 12 IAMD (O SwfEPs (78/ A <br /> SITUS/FACILITY ADDRESS: <br /> DBA: Do O�:d wJ36J nAJ- <br /> BILL TO: PHONE: - -7/0? <br /> BILLING ADDRESS <br /> CITY/STATE: Sr/oc k*w Cll ZIP: <br /> PROGRAM: f, &Sr TYPE OF SERVICE: U65r Clo5a [ �Ia�/ flr✓iPW <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 /> f 3AM- 4:30PM-SAM/ <br /> RVICE 4:30PNI WEEKENDS <br /> bl <br /> TOTALS 3 Q <br /> BALANCE DUE: ill <br /> BILLING DATE <br /> EH 23 074 (Rev 3/91) <br />