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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # <br /> SITUS/FACILITYADDRESS: /'Ws /�JJ �r i S'/ s�'pp�.4/�^ <br /> DBA: ✓o ton ac uk` Kc ( fo.�� i+ • Jv� DLaeJ*cn <br /> BILL TO: UV%Led PAC t�`t �.�-� 1 ro4.j PHONE: <br /> BILLING ADDRESS: S1- <br /> CITY/STATE: ZIP: <br /> PROGRAM: TYPE OF SERVICE: �in Ie�CKCy �cS pc.� x <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 SA?vf- 4:30PM-SAM/ <br /> SERVICE 4:30PD4 WEEKENDS <br /> -S- 93 -5:,3L> <br /> i <br /> i <br /> TOTALS p <br /> BAL�NCEDUE: �•5X7o �6-07- <br /> 13ILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />