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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # � G <br /> COMPUTER/PERMIT # ae V/Z I /?6 <br /> SITUS/FACILITY ADDRESS I6 ?> W. I I <br /> DBA: <br /> BILL TO: \(\j EN G1 4- PHONE: 3z%--eI31©� <br /> BILLING ADDRESS: <br /> CITY/STATE: /� �� i {i4'� ZIP: <br /> M: <br /> PROGRAyGST TYPE OF SERVICE: ?11'-V) <br /> �f 11'-V� Fac' ill ce") E ? / j �L L <br /> d <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIIvfE IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAIME <br /> of SAIM- 4:30PM-SA,NI/ <br /> SERVICE 4:30PM WEEKENDS <br /> z41 ll :oo - lZ;ao 1cG� �/ �_ ..�, <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />