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ENVIRONMENTAL HEALTH DIVISION <br /> /X12 ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # <br /> SITUS/FACILITY ADDRESS: <br /> DBA: ND���MAN 3PJ55 , 1I12 � 7!/��G �l�L l <br /> BILLTO: / PHONE: <br /> BILLING ADDRESS: Orli-� S-7 ---? —7 <br /> C7Y/STATE: //�Wr wl '!� ZIP: �� 3 / 4 <br /> PROGRAM: s T TYPE OF SERVICE: itie `✓ I�� l' I -7 1 �� <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO TI-IE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 8AM- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> 16. ✓ <br /> TOTALS <br /> BAL1`lCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />