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. • <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # l NU E / I7a7 <br /> SITUS/FACILITY ADDRESS: I SOO N , S� a t) , 91k, ,v _ <br /> DBA: L.�kNI, l 2PiY1) u �l 19r�� ` <br /> BILL TO: _ � PHONE—p 16) 1, <br /> BILLING ADDRESS: <br /> CITYISTATE: ZIP: _ � <br /> PROGRAM: 0 3. TYPE OF SERVICE: <br /> (�L G <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL. INSPECTION TIME I COMPUTED TO THE <br /> NE T HALF (1/2) HOUR INCLUD[N TRA L TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAIVE <br /> of 3A?VI- 4:30PM-3AAM/ <br /> SERVICE 4:30PDI WEEKENDS i <br /> IV,'t 9 :OD- ;3v ;30-6:co z•s n� �k lkY "t L, o F /v1 <br /> I.SOT <br /> 1y,2S <br /> 5 � <br /> 7z.zs I I <br /> I <br /> TOTALS <br /> BALANCE DUE: 3 , <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />