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5� <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERiMrr # (2 AAJL/ o)y <br /> SITUS/FACILITY ADDRESS: 9 <br /> DBA <br /> BILL TO: h/e/n,4; PH10 <br /> BILLING ADDRESS: a/ J / AJ . Ca /r/uii 4 /dcP sy iL{ 3 7a <br /> CITY/STATE: V a C t-e of <br /> ZIP: <br /> PROGRAM: �. _TYPE OF SERVICE: 'C-/oSu-,.e in p/ n o/anrepl - <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TAg 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 /> /S9•4? <br /> s m- o i a ,aivs <br /> v N/ <br /> Co,7 sv , ✓� /J/ <br /> t-e /U/ <br /> 9 /y2 A' 9o0 . '� I crdq�Pir �..,-, -elj•.:y,.v .v/ <br /> Av <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />