Laserfiche WebLink
ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT #�� /Zc� <br /> COMPUTER/PERMIT <br /> SITUS/FACILITY ADDRESS: /�3-73� <br /> DBA: Otv/1�4�Coyr �ff�(/�jQL�f <br /> BILL TO: (Gy PHONE4�04) 5Z4— <br /> BILLING ADDRESS: <br /> CITY/STATE: App oc5"-7ry Gk 9r'J 35 ZIP: <br /> PROGRAiVI: SO TYPE OF SERVICE: �E�ay�L rLGoS�RE /�Grl�cV'/2�V/�� <br /> THE MINIMUM TUa FOR EACH INSPECTION IS ONE Cl) HOUR. ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUU 6-T%XV -- <br /> ZLt <br /> DATE <br /> DATE WEEKDAY __H ESCRIPTION OF WORK REHS NP VIE <br /> of SAM- 4:30PM-3AlvI/ <br /> SERVICE 4:30PM WEEKENDS <br /> Ao - # <br /> h.A ^^ <br /> / 3.eo 3--Iy Lr i� �RILET//Q <br /> ] J G <br /> ga- a�uu �frivl� S �T«'1- ��2Ic <br /> y <br /> 4r,, r- Refoo✓a/ 5--�pti , <br /> ,eels~+ w— ted / <br /> i y:u5 q;.v A?t a E_ 2P�v�t�yL <br /> til o�F N�uM Ve'P��c rFR E-TAfiEfiQ <br /> 11/7`GIl -7:Gt�-9' <br /> TOTALS No laxt- V6 f AL <br /> IIAL'LNCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />