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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # I� _ <br /> COMPUTER/PERMIT # RQ p kh 5( /Ila?15 �/ <br /> SITUS/FACILITY ADDRESS: `J 1 S >d byli✓iJ O 66-. <br /> DBA: b )l ( L ( avi, �9�� <br /> BELL TO: N i Ad— CP9zi PHONE: <br /> BILLING ADDRESS: s( J I`-U <br /> CITY/STATE: Lod-� ZIP: p y a o <br /> PROGRAdM: a 3 . &D TYPE OF SERVICE f e - Q/Y�o�II u`Fi'rh cJ t �c�C S[¢�yuf �i <br /> THE WNDAUM TMM FOR EACH INSPECTION LS ONE (1) HOUR, ANY ADDMONAL INSPECTION TWE IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> S a <br /> WEEKDA WEEKNIGHT HOLIDAYS DES M N OF ORK REHS NAME <br /> 8AM- 4:30PM-8AM/ <br /> 430PM WEEKENDS <br /> :co .3 ;?e <br /> pe---s <br /> LIM <br /> 30-4 00 Rei, <br /> TOTALS �y <br /> BALANCE DUE 10 <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />