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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # 3 <br /> CO�iMPUTER/PERMIT # C3 <br /> SITUS/FACILITY ADDRESS: _ �� y u ��� S4 <br /> DBA: 4:;,c /c Aos� -- <br /> BILI.TO: ,y�,P�icc�cc r� <br /> BILLING ADDRESS; I-A Ile <br /> C[TY/STATE: s d �. P,. c' ,4 ZIP: 95c2 <br /> G�Lr�6? G vzr�x� <br /> PROGR41"M: TYPE OF SERVICE: ,�f iY.ns> ' /.� /�r ltG.�_ct /`r STc <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 RENS NAME <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 4:30PIvi WEEKENDS <br /> r, N <br /> -3/ l r,J ,, l /f l;r <br /> J,(A4o✓� ' <br /> TOTALS <br /> RALkNCE DUE: 13,z <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />