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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # Ul: ZS/ <br /> COMPUTER/PERMIT # I LLIA I q #� � <br /> SITUS/FACILITY ADDRESS: I yD f e rd I ng l I�CIU S�bCI!fcr, <br /> DBA: UI IIQae PYD�r�t S <br /> BILL TO: W !l /" r// V/r0Y1/YLP,/4i7 ��jyl � yTs PHONE: 579-8/3B <br /> BILLING ADDRESS: <br /> P. O . enx (� 7 2 9 <br /> CITY/STATE: / if `L%&,5& ZIP: <br /> PROGRAM: UST TYPE OF SERVICE: T/D//79 r&M?IVa.Q ` S�• <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 /> w�4 <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> 31 qZ I '3 00 2� + Pipe-vemav 1N/L <br /> 10//8 q 4:9` i�ro�e fP PiPi' rem.ov �" Ua tY <br /> TOTALS <br /> BALkNCE DUE: ✓f <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br /> l / " <br />