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i <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> #CEfJ`S/7 <br /> COMPUTER/PERMIT # ,-)s7� / <br /> SITUS/FACILITY ADDRESS: /?mss ti' /3roa c� . S��h Y saU S <br /> DBA: �¢o. tie y- Sc /Iu/u <br /> BILL TO: in C5 PHONE: _ 9 Y� SSu <br /> BILLING ADDRESS: e13/ 6t <br /> CITYISTATE: SA ZIP: <br /> PROGRAM: / C/6 TYPE OF SERVICE: DfonrnwoiJ� /n <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE Cl) 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- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> X7/9 <br /> B42144L 9Bo- 43od C/nwQ "-"a &4 <br /> 2 '3 � <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE <br /> EH 23 074 (Rev 3/91) <br /> I <br />