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ENVIRONMENTAL HEALTH DIVISION 77w6 <br /> ACCOUNTING WORKSHEET <br /> UNIT # _!L� <br /> coMPUTER/PERMiT # �3���//►J /A C} <br /> SITUS/FACILITY ADDRESS: 5-37 <br /> DBA: f'1 , T LJF,'m-z, CO , <br /> BILL TO: 5 -7 I PHONE: ��7�1y z30 <br /> BILLING ADDRESS: <br /> C=/STATE: /7� ' V- / y ZN Srl ZIP: �i{537� <br /> PROGRAM: U b 7� TYPE OF SERVICE .7J A7._) ('M �L_ , 1 /a" <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 TA4E C ( if/1.7 <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCR]]FTION OF WORK RENS NAME <br /> of SAM- 4:30PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> z <br /> ,� zCA 83 lc S Gd � 2/z <br /> TOTALS <br /> BALU`ICE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />