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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # //DZ <br /> COMPUTER/PERMIT # �7 DIn <br /> SITUS/FACCILITY ADDRESS: ri)ntano, ?give. <br /> DBA: 1 / <br /> BILLTO: Q PHONE: �3L <br /> BILLING ADDRESS: /�� �j <br /> CITYISTATE: �II�ICl � �/ ZIP: 7 5Z0 l <br /> PROGRAM: U ✓ 'TYPE OF SERVICE: Inn mw"-L <br /> THE MINIMUM TUYIE FOR EACH INSPECTION IS ONE (1) HOUR ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST 2) H90R. INCL. TRAVEL TIME. <br /> w. G kl � <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK RENS NAVfE / <br /> of 3A.Nf- 430PbI-3AM/ <br /> SERVICE 4:30PNI WEEKENDS <br /> :71,q q� I i•3o I l V �Ttw o oL T <br /> WI-frLe- c v mcyv o -r <br /> 3 ID: 30 lz 00I tom✓ I•S lG W p r�m av +Grnfa► . V'(/d <br /> 3o - I I VV s ev 2kJ 3 f/I OV <br /> mUUac <br /> I <br /> i <br /> TOTALS <br /> II.\L\NCE DUI-, 1 .59. <br /> 13ILLING DATE: <br /> EH 23 074 (Rev 3/22/91) / <br />