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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # -,tfSPiAv G /o <br /> SITUS/FACILITY ADDRESS: /L-."-i <br /> DBA: S /� i�K �k•� <br /> BILL TO: PHONE: b j 7iu! <br /> BILLING ADDRESS: O, 1�5Ux /o s 7 <br /> CITY/STATE: c/LSD// ZIP: <br /> PROGRAM: yS FAD Gtr TYPE OF SERVICE: �'ur Pv'C✓/r�i v C v os�'c�i ._ <br /> uh� _ <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. nn <br /> l/ /-ter 0- r-r.,,.0 -t,�-� -1K s <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK :REH:SNA]lNMlFE <br /> of 3Am- 430PM-3AM/ <br /> SERVICE 430Pbt WEEKENDS <br /> (C' PJ ` <br /> ( //Z-Z2 Z 1, <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE <br /> EH 23 074 (Rev 3/91) <br /> I <br />