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i <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # L <br /> COMPUTERIPERMIT <br /> SITUS/FACILITY ADDRESS: _ �za!zo <br /> DBA: <br /> BILL TO: / !- cf �A PHONE: o0q) <br /> BILLING ADDRESS: -7 oQ 6� ff e <br /> CITY/STATE: . ' fF ZIP: <br /> --i�' <br /> PROGRAM: �L� �=-�� � TYPE OF SERVICE: �-j7 u-- Q' 919 <br /> THE MINIMUM TIME EOR 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 REHS NAME <br /> of SAM- 4:30PM-3AM/ <br /> SERVICE 4:30PNi � WEEKENDS <br /> s- <br /> '.s c <br /> —,t" 00 cL S <br /> C <br /> =TOTALS , 77711 <br /> IIAI,kNCI: DUE: <br /> BILLING DATE; <br /> EH 23 074 (Rev 3/91) <br />