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ENVIRONMENTAL HEALTH DIVISION <br /> ��n / ACCOUNTING WORKSHEET <br /> UNIT # �/-��I QLJ <br /> COMPUTER/PERMIT # ��✓� 1�6. �" �� <br /> SITUS/FACILITYADDRESS': 7 (i "/ 9X-377 <br /> / <br /> DBA: Q}��/�� V c /egg( <br /> BILL TO: T/� / �/� ✓/�.20n1M' /ft�tllTA-t� ��/Z ✓tCef ONE:ZQ� ,Ko-d7SB <br /> BILLING ADDRESS: / <br /> l/ <br /> CITY/STATE: / 1__�ZL4 ZIP: ?537-b <br /> PROGRAM: (t7 TYPE OF SERVICE: �eerk, Ra4tt4 VA} - +-cia / /�7 <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 /> LDAEJWEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> 8AM- 4:30PM-8AM/ <br /> 4:30PM WEEKENDS <br /> °,2 PL ✓ l� <br /> 3J ka1144✓ <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />