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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> LIMY # -3 <br /> COhIPUTER/PERMIT# ay36 <br /> SITUS/FACILITY ADDRESS: <br /> DBA: GtJA6Pr PO/�f <br /> BILL TO: 7,; or 0;1/ P?:01\lE: ?ylp - 3L,f (o/? <br /> BILLING ADDRESS: <br /> CITY/STATE: Z o�F C'/� ZIP: gs>v/-035-7 <br /> PROGRAM: TYPE OF SERVICE: �/Gnoo-Ari: J oV4 irrs�cl��oiu <br /> Tun,Es <br /> THE IVIINIMUM Ma 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 SAM- 4:30PM-SAMA <br /> SERVICE 4:30PM WEEKENDS <br /> uc 3 Avco - vie..) c?.?d 5&fc un <br /> 3- 4/ 3 /YJ— / lQ r vi <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />