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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT L1--7 <br /> COMPUTER/PERMIT# <br /> SITUS/FACILITY ADDRESS: <br /> DBA: <br /> BILL TO: PHONE: <br /> �aGo�T Co. [war-3337 <br /> BILLING ADDRESS: NY/4F.re- <br /> CITY/STATE: 5;P/4,0� n/€Y.444 ZIP: 39 4.3 <br /> PROGRAM: 23 TYPE OF SERVICE: <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 /> DATEWEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PM-SAM/ 4W <br /> SERVICE 430PNI WEEKENDS <br /> 7 <br /> 4 E vim/ ' R 4- N4- <br /> 1 lol Q Fw �?�?6vEN/L N� <br /> slis/a 1 2' 'yeti 3Yojlyl ,a __ G414 REvf 6ry iQEvEN✓a— N4 <br /> .14yrrdw Trns. EjvtL NA- <br /> / y! c.�ri I°Eurbw � <br /> Fl(Za 8=rcw-fo. � I 2rJ��/./4,��.ara� lL 6nl/l NA <br /> em&f 4.vOq _Q.'r!� I•>< r�rj-o-- rlrk ^p,,,xr L Nk <br /> Z�t>-rr1+66+4-T� iJEw FAIL I <br /> 6 /k779cLTrJ rlfi26vF-Al�— "C <br /> -7XIV9 AtP ,144— A- <br /> rr a 4/ 9:3�„_p• I t�Pro�N6 �Ns/r�ri o/�f F,q.v <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />