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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTERIPERMIT # <br /> SITUS/FACILITY ADDRESS: —rartana, ))-r)y2 <br /> DBA: <br /> BILL TO: Q PHONE:-I�3l <br /> BILLING ADDRESS: <br /> �/ I • �• 60A I ?,Y/S ✓q / / <br /> CITTATE: 51 3U1\ (^ ZIP: g676) <br /> PROGRAM: V ✓ TYPE OF SERVICE: <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDMONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST 2) H R, INCL I TRAVEL TBv1E. <br /> ti 3 2- w� <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 3AbI- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> w 9Z 1302,30 I w�o AIT <br /> IOsN �I� W/fkV>,"52 <br /> 3 v 10:30 oO Ilr✓ IS 1vt is V reomfy -eemok <br /> n <br /> Z� �2 8 ' 30 oU I I Lv Slv .4 n, 0,10AU l/il eGdV <br /> j <br /> TOTALS <br /> BAL'LNCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) / <br />