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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # ( OMME" /E ;r-k / G 5 <br /> SITUS/FACILITY ADDRESS: <br /> DBA: s i yre- <br /> BILL TO: nI DwiM/n��rCi�� %✓4✓tS Inc PHONFZZo9) a7S Oy'/y <br /> BILLING ADDRESS: 00 e/ <br /> CITY/STATE: C) ZIP: c1377 <br /> PROGRAM: 3�U TYPE OF SERVICE: <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- 430PM-SAM/ <br /> SERVICE 430PM WEEKENDS <br /> IS-5 'S 30- /-t 7 SO: I R lig ilea 44 l"iT /v <br /> TOTALS �r 3 .s oP, <br /> IlAL1NCEDUE: -zw a73. <br /> BILLING DA'Z'E: <br /> EH 23 074 (Rev 3/22/91) <br />