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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # � ;?-Uc�tj <br /> COMPUTER/PERMIT # �� qA <br /> SITUS/FACILITY "IOOADDRESS: ?6 Jr VV• <br /> DBA: �e1l.I� ?lace-- + / <br /> BILL TO: lo-nu-2 LOOP-kS12't l 1_w' I' PHONEZ6'I, q&,? 916 <br /> BILLING ADDRESS11 '1: 3) W <br /> f5 • l7 lI I n <br /> CITY/STATE: ")tt�c_K I-UA- n ZIP: <br /> PROGRAM: V TYPE OF SERVICE: iVYIhVAl <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 /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 8AM- 4:30PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> V(c hl , V 7 KnsPt /moi <br /> ir. <br /> ��,•) 7l �� fy, /� �0mcv.�- �%s�I Moir'? <br /> Jc f! /o 0o n`J omcvxQ ur v <br /> TOTALS <br /> BALANCE DUE: <br /> BULLING DATE: <br /> EH 23 074 (Rev 3/91) <br />