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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET (/ <br /> UNIT # 3 • <br /> COMPUTERIPERMIT # rgn-roR /-1,- <br /> SITUS/FACILITY <br /> SITUS/FACILITY ADDRESS: / y S cvs .4c�o �'cfcfrn P9 5 v <br /> DBA: r (u GNPs <br /> BILL TO: cu✓ <br /> r PHONE: <br /> BILLING ADDRESS: 3 o N��'r"� o n ' <br /> ZIP- <br /> CITY/STATE: 5 (_v 4 <br /> PROGRAiM: /QHS I #D G! TS TYPE OF SERVICE: � un rty��� _�ccfrv►• � 1�� <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 ItEHS NAME <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 4:30Ptii WEEKENDS <br /> - �V w�'►"wc�7n C�YLQij�' <br /> r c/rf4.J <br /> ` /.l '7t 61 AJ) <br /> t <br /> I <br /> TOTALS <br /> II,%LkNCE DUE: <br /> BILLING IMTE: <br /> EH 23 074 (Rev 3/22/91) clI <br /> i ! <br />