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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # (( `/ / <br /> COMPUTER/PERMIT #.5x dAA6/toe 2� ✓ /V p IN <br /> SITUS/FACILITY ADDRESS: / `, s4 7� ! s'3 7 6' <br /> DBA: <br /> BILL TO: /.Lfj� i 6--,Z V I C C " C PHONE: <br /> BILLING ADDRESS: <br /> CITY/STATE: G . ZIP: 'II1 7 <br /> PROGRAM: U (1-t E OF SERVICE: �� ����^a VA <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 <br /> 11-2 <br /> TOTALS <br /> BALUNCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />