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' ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # /Z 63 <br /> COMPUTER/PERMIT # <br /> SITUS/FACILITY ADDRESS: i' �r <br /> DBA: 6lh.�� <br /> O: C� PHONE: <br /> BILL T <br /> BILLING ADDRESS: �/ �D�C <br /> CITY/STATE: ZIP: <br /> PROGRAM: TYPE OF SERVICE: <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NE. T (1,/2) OUR, INCLUDING VEL T11-4E. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PLM-SA I <br /> SERVICE 4:30PINI WEEKENDS <br /> o a r 1'.F,vt�w G-evrL. � f Y, <br /> Mb q-zi /D:� Su ntt� { �/ f <br /> /I1 <br /> yorl , <br /> TOTALS 5(6AL,e- f�) <br /> B,\L\NCE DUE: r <br /> BILLING U,\'I'E: <br /> EH 23 074 (Rev 3/22/91) <br />