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ENVIRONMENTAL HEALTH DIVISION <br /> f-�1 ACCOUNTING- WORKSHEET <br /> UNIT # <br /> COaNIPUTER/PERMIT # 7 LI LY fc' 'a <br /> S[TUS/FACILI"TY ADDRESS: <br /> BILL TO: . /I [�to L PHONE: <br /> SILLINO ADDRESS; ] �,I, f✓ _._ <br /> CITY/STATE: ZIP: <br /> G�'�t- C . , <br /> PROGRAM: /r TYPIC OF SERVICE. GL15 f Tj j <br /> .Ae 2Ll tita <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL IN6ECTI0N TI]MF IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. j <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRTPTIOt-i �9F WORK REHS NAIME <br /> or SAM- d:30P,IM-SAM/ 3 <br /> SERVICE 4:30Pr`I WEEPCENDS �, <br /> 7 �T,��37[�/ t�-v [ L <br /> eli -4 <br /> / ! 4 <br /> S, <br /> r <br /> J o;0o 1 I'.c fiVl C'�yt1L h' el <br /> Al. . <br /> e <br /> /V NTOTALS <br /> BALrNCE DUE: <br /> BILLING ImTr: <br /> FH 23 074 (Rev 3/22/91) <br />