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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # _y(/ <br /> COMPUTER/PERMIT # <br /> SITUS/FACILITY ADDRESS: <br /> DBA: `SYlLK I�I7T- Fvor�//i4r <br /> BILL TO: PHONE: 33 l"5 <br /> ' ! t-X37 <br /> BILLING ADDRESS: <br /> CITY/STATE: 5y-WhC S /1/,611804- ZIP: 43 <br /> PROGRAM: Z3- 5�V TYPE OF SL-RVICE: <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TWE 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 SAb!- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS u,.4/V <br /> tom <br /> =uo.w12:'o/ 3 /oP/PrN(rZNS�Ec/i�l �TK6vFN/1- 14A <br /> /vl-7/4 1 act+w—/O:gry ,4 I'I4 <br /> /v(7�"t 2°OiPrnIG T.�I�aF>EG�ionl T� /,j4 <br /> o�%'/Q/ 3-ice -�(.iu I f car �N,z� •ri IV4 <br /> .,/� fTieEvf� <br /> /�//�jy ID•Ut,a -/a:y X22 FylVi4L,lJEGT/D/�[ E' v � <br /> /v z/ a/ /r3v-/y.aN •so F�/1G4/—yn(SpEGrTia�f �• ,�� N,� <br /> /"/z/6( /-amu/,. -3:..u/,, F�N.4L ZiVs/�F��7o�/ LTi°-� 4 t NA <br /> TOTALS <br /> BALkNCE DUG: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />