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ENVIRONI'v1,ENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> MMPUTER/PERMIT # Q C= f F340 <br /> SITUS/FACILITY ,ADDRESS: <br /> DBA: P6 �6 , <br /> BILL TO: 'o C PHONE:C��I <br /> BILLING ADDRESS: "�� �� <br /> CITY/STATE: ZIP: <br /> PROGRAM: TYPE OF SERVICE. r4P l C <br /> THE V1INI4fUVt TME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIIME IS COP4FUTED TO TINE <br /> NE-WST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY SVEEK.NIGHT HOLIDAYS DESCRIPTION OF WORK REHS N.kmE <br /> of SAM- 4:30PrIM-SAIM/ <br /> SERVICE 4,30PM WEEKENDS <br /> 1 3 - d ] I :1. -d i+s it <2J I <br /> 3 "Il-4 1 ' <br /> t/�l7 s <br /> TOTALS ' J <br /> I <br /> II.tLtNCC DUE: � ^ <br /> MILLING U, TE: <br /> Ei 23 074 (Rev 3/22/91) <br />