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0 4 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # JL 4 y'�) <br /> COMPUTER/PERMIT# SSR D 6 3 g(��// - � ��l 7 L L <br /> SITUS/FACILITY ADDRESS: C rn s J IT a <br /> DBA: r / <br /> R � � o `f <br /> BILL TO: 4- PHONE: ]oZ, <br /> BILLING ADDRESS: I ! ) /V <br /> CITY/STATE: LS/ `C �D V,� / /1 ZIP: _/ O� <br /> PROGRAM: �3 COO TYPE OF SERrVI ' e U) '1' USC. e ,3 -/I d� <br /> a-)rl) : * 6;� <br /> THE MINIMUM TIME FOR EACH INSPECTION LS 0 (1 OUR, ADDMONAL INSPECTION TIME IS CO TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TR¢ <br /> WEEKDAY WEEKNIG HOLIDAYS DESCRIPTION OF WORK REHS NAME . <br /> 8AM- 430PM-8AM/ <br /> 430PM S <br /> fev <br /> TOTALS <br /> BALANCED <br /> BILLING D \ <br /> EH 23 074 (Rev 3/22/91) n /\ <br />