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ENVIANMENTAL HEALTH DOISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PL-RbIIT # <br /> SITUS/FACIL= ADDRESS: <br /> DBA: 1Qo <br /> BILL TO: Q/L EGy/f'�iET ✓AGE PHONE: <br /> BILLING ADDRESS: ,9L) /30� SSD <br /> CITY/STATE: %�[V �31�//�i�'L/�/ c,/� ZIP: <br /> PROGRAM: TYPE OF SERVICE: <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMP=D TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> v rh <br /> DATEWEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> E___i_ <br /> yC1L 3;ov-3:3[� <br /> i <br /> TOTALS /f, �-5 <br /> RAL\NCE DUE: <br /> BILLING DATE: <br /> FH 23 074 (Rev 3/22/91) <br /> i <br />