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ENVIRONMENTAL HEALTH DIVISION <br /> `� ACCOUNTING WORKSHEET <br /> UNIT # 3 �� <br /> COMPUTER/PERMIT # IM <br /> SITUS/FACILITY ADDRESS: '7S 1)a l/✓ /,✓I S <br /> DBA: ,A�i/�, 7r ie z/o� '% pit SSP / <br /> BILL TO: 3� �/C S � 60 2-6 ,f PHONE: -,a/p j�3 Virg- <br /> BILLING ADDRESS: Z yU $,I e. <br /> CITY/STATE: I RP5/, N V —( ZIP: <br /> PROGRAM, QV —r TYPE OF SERVICE: �I�r� ✓G`� C � y"�11 <br /> THE tM MMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TR%4E. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 8AM- 4:30PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> TOTALS <br /> BALANCE DUE <br /> BILLING DATE <br /> EH 23 074 (Rev 3/91) <br />