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0 4 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT <br /> CONIPUTERRERIMIT # / v <br /> SITUS/FACILITY ADDRESS: <br /> DBA: 2a4 1&44 �iel/2�T CO <br /> BILL TO: 'rll�t T1 F. /OZLt42M R��r�1 PHONE: <br /> BILLING ADDRESS: f Nf ?� <br /> CITY/STATE: ZIP: <br /> PROGRAM: Uzi, SM TYPE OF SERVICE: t F al/AL OC U65 - <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 WORN REHS NAME <br /> of SAM- 4:30PNf-SAIW <br /> SERVICE 4:30PIyf WEEKENDS <br /> U�ZZ /a�ri J v4E <br /> TOTALS <br /> IiAL\NCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />