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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # _ <br /> COMPUTER ERMIT # f�5 <br /> SITUS/FACILITY ADDRESS: <br /> !>�C KVv�r�nl <br /> DBA: —6` 2jc:�, O IDIS <br /> BILL TO: O_ <br /> ural r..P <br /> � ' PHONE J.,q icy I&r� <br /> BILLING ADDRESS: �. <br /> CITY/STr1TE: f, ,✓ AA-k,/�x <br /> ZIP: <br /> PROGRAM: 6(6-S7— TYPE OF SERVICE: /PPM14U2� Ojt n- <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 SAM- 430P,M-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> iO ff RGt ec v <br /> ee,o� <br /> ix:v5- I uSN,.� �P✓Gll--void <br /> v,A'e- <br /> TorALs <br /> RALINCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />