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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # 11 <br /> CONlPUTER/PERlVIIT # �t/y�o <br /> SITUS/FACILITY <br /> , ADDRESS: b o �. rJ ST, / 6 ��376 <br /> DBA: 1 //��5�/��l//� —7A^Tn &A O-V(V k� <br /> BILL TO: /"-C- A h I�(`� k kea, 0V A+(-- S 1)e,kh E <br /> BILLING ADDRESS: q!gtgo 14 r L \/ 1tZ06 S <br /> CITY/STATE: ZIP: <br /> PROGRAM: U(rS'r TYPE OF SERVICE: �D V��I -a V/} c� <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 4:30PM WEEKENDS <br /> d � 1 *0 — 2 'o PP tG'✓�}t, r� <br /> - eve G✓/� <br /> io.30-;�; pp__ <br /> o�,� l�l'tio✓A� °L ' w <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />