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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT �Zr <br /> COMPUTER/PERMIT <br /> ycf C Oo�z S7 C.� 6 <br /> SITUS/FACILITY AI;DRESS: <br /> DBA: &-a t � 5� <br /> BILL TO: MLD PHONE21�p� <br /> BILLING ADDRESS: Lq JUv <br /> CITY/STATE: o es �} ZIP: _/f <br /> PROGRAM: TYPE OF SERVICE: ��I� 1pr-_ ,< 1�!iW�U� �`�' <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 /> 3 )t�-e ✓i ee.J 4 <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />