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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # _/// <br /> COMPUTERIPERMIT Gf C f rt , I C��,� L•� <br /> SITUS/FACIL,IT rY ADDRESS: <br /> DBA: <br /> BILL.TO: - c— Y � C� PHONE: � � c •.�, " `� l <br /> BILLING ADDRESS: <br /> C ITY/STATE: <br /> f !/L,..4 �.F'r�� � / J� ZIP: <br /> ,�-� ,fir+ <br /> PROGRAM: � 67 -� TYPE OF SERVICE: _ �L- �l � 1��� �'C Lr <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR., ANY ADDI'T'IONAL 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-3AM/ <br /> SERVICE 4:30PNI � WEEKENDS <br /> :J <br /> 'r 001 <br /> 3c <br /> 7 � <br /> 1'r oo -J, 00 <br /> J� <br /> TOTALS j v, o <br /> BALr NCE DUE: <br /> BILLING DATE, ,�s /Vq�" <br /> EH 23 074 (Rev 3/91) /U= 4�% <br /> 000 ` ,� <br />