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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # ZI ^ <br /> COMPUTER/PERMIT # �^ �Z <br /> SITUS/FACILITY ADDRESS: �7 `J O ✓ DON �'di / l' vim/. N� �S��b <br /> DBA: <br /> BILL TO: I m OF i 01'�- -T'NL PHONE: <br /> BILLING ADDRESS: el F) - 157 <br /> CITY/STATE: L <br /> � A� 6A--1 , ZIP: <br /> <;(T <br /> l✓ /d 3s/ <br /> PROGRAM: V Ir ; I TYPE OF SERVICE: P(A-H c,.,eaG -T"[L-[L- re-k o` AL-5 <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- 4:30PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> 12;io-2;3ti h�' lit/ <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />