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ENVIRONMENTAL HEALTH DIVISION <br /> 1 ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # <br /> SITUS/FACILITY ADDRESS: <br /> DBA: h I ITI hG 7U \/ C�(�� �aS� /��p <br /> BILL TO: M / OT/� I'S T� ]ld o NC)kG�iONE .S1G 77f V Or7 <br /> BILLING ADDRESS: ! ��d J 5 V�l}j,-,(-1/: P—b G <br /> CITY/STATE: _ �j-; �)/ { I i tj� —/ 7 62 C� ZIP: I C� <br /> PROGRAM: TYPE OF SERVICE: R2 PSN <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTIO TTTIIIIIIvvv. IS COMPUTED TO <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. 11 > <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PM-8A,M/ <br /> SERVICE 4:30PM WEEKENDS <br /> -Z Gf}r/ /2e V 14 <br /> _m"K lrQiru o c— /2 <br /> L S <br /> rorALs <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />