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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT# '4;W <br /> COMPUTER/PERMIT # <br /> SITUS/FACILITYADDRESS: _ 004,(+V6 -o <br /> DBA: V e-< y <br /> BILL TO: �Q//��n,P_( '(�n� PHONE <br /> BILLING ADDRESS: G '7 e pQ�� (/L So iA f �y <br /> CITY/STATE: N L��f I ZIP: <br /> PROGRAM: Ur�� TYPE OF SERVICE: /"/ C`I 7" a-4� <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY.p�DD ITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME, 7►/OP <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PM-BALI/ <br /> SERVICE 4:30Pbf WEEKENDS <br /> 7G� S" `� <br /> TOTALS <br /> BALkNCE DUE- <br /> BILLING <br /> UEBILLING DATE <br /> EH 23 074 (Rev 3/91) <br />