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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # /y4r:!� ,l0 , / <br /> SITUS/FACILITY ADDRESS: ���7` N- � r 44z <br /> DBA: exiQ <br /> BILL TO: /C• fw44SG� Cd ' PHONE: <br /> BILLING ADDRESS: AO• _&z)X 3o5 -77 <br /> CITY/STATE: S!OG��T�1 G� // ZIP: <br /> PROGRAM: 2 .3. 8e' TYPE OF SERVICE: <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 /> SERVICE 4:30PM WEEKENDS <br /> 9 (2:5o^- :I p, C ,n.n.n /e-ova /Gvi lAwd <br /> C- <br /> 4 116 lei I <br /> AyivA <br /> 9 (/ _/ I N L/VUH Tr TIMN (t✓ Na F4.✓ 3.IRA/Lr <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br /> v <br />