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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # <br /> S[TUS/FACILITY ADDRESS: <br /> DBA: <br /> BILL TO: <br /> 3 S ) 6 lV�� PHONE: <br /> BILLING ADDRESS: <br /> ZIP: <br /> CITY/STATE: <br /> ERVICE: <br /> PROGRAPROGRAM: 5 �a TYPE OF 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 /> / ✓yYl i � f i���C. 1 . . � <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS N UME <br /> of slaam- 4:30PM•3ANI/ i r 5 ,l-f <br /> SERVICE 4:30PM WEEKENDS <br /> O_ <br /> 5- - <br /> Sr- <br /> -7-1 1Q <br /> y"l <br /> TOTALS <br /> fiAL\NCE DUE: oo <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />