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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT <br /> COL'yIPUTER/PERMIT # CIT3 r6 <br /> SITUS/FACILITY ADDRESS: <br /> �/ zA�oo:y, <br /> DBA: (jcxsr�. V/�J�'`1Gtfr,�C <br /> BILL TO: _65za e? t//�,)f ' PHONE: 22� <br /> BILLING ADDRESS: �2Cb� vti Y� <br /> C(TYiSTATE. ZIP: 5-3 3 6 <br /> PROGRAM: TYPE OF SERVICE: o4- 9"ow so f SU h, �✓ /��°II/� <br /> 7HE ,MINIMUM TIINIE FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS C014fPUTED TO 7FE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30P,LI-3A1tiI/ <br /> SERVICE 4:30P�I WEEKENDS <br /> Sm <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />