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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT <br /> COVIPUTER/PERMIT <br /> SITUS/FACILITY ADDRESS: lir _S• `;, ' <br /> DBA: <br /> 5. �.� 0PHONE: _, cf <br /> BILL TO; <br /> SICCING ADDRESS: Y 31 c <br /> v r_f�=S�� ZIP. <br /> CITYISTATE: j <br /> PROGRA,tif: G T(!?'�S/�"r�Q� TYPE OF SERVICE: ,//,7/Ci f'r�c1JL e�/Pu✓ vi i <br /> Tru. MINIMUM TIlaSE FOR EACH INSPECTION IS HOUR, ANY ADDMONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HAL: C1/2) HOUR, INCLUDING TRAVEL <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 3A1M- 4:30PM-SA.ML / <br /> SERVICE 430P:Yi WEEKENDS <br /> oru.cQ f .© D e Lc, - �► 3 nISS 6A GUt 2lp <br /> . <br /> I&Zy?�/� s r f vvf / .crt G t-�• L�G <br /> s rd /go, prn - <br /> Cc <br /> L4eroti ua4� sf. <br /> 11, <br /> r I <br /> TOTALS <br /> I3AL.kNCL DUE: <br /> FILLING DATE. <br /> EI-I 23 074 (Rev 3191) <br />