Laserfiche WebLink
ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # �- <br /> COMPUTER/PERMIT # <br /> SITUS/FACILITY ADDRESS: <br /> � �Z.3 ,�• /�� J,, _ �y���71�✓J ^ <br /> DBA: <br /> BILL TO: vrb TnV2 S �jroW12Iga"4M&" SP HONE:'r I��U <br /> BILLING ADDRESS: 181 r gl vc, <br /> CITY/STATE: ' s <br /> � f ZIP: <br /> V <br /> PROGRAM: 5T TYPE OF SERVICE: Iy11LSl� <br /> THE MI MITJM THAE FOR EACH INSPECnON IS ONE (1) HOUR, ANY ADDITIONAL. INSPECTION TWE IS COMPUTED TO THE <br /> ST :4:�3OPM <br /> INCLUDING TRAVEL TI M. <br /> 10 '1S-R2 <br /> Y WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK RENS NAME <br /> WEEKENDS <br /> boy--,, <br /> WEEKENDSID'l9�Zini I vt 6 <br /> lo,z,o (: Zoo ► h "' hr !o 1 1' <br /> fJ �i+e �n�Q•w contra .F <br /> ,b-Zq- no <br /> 92 trot yZ pmo mp► w .,,� a pi.,.ti. <br /> q Subm�� s +- ap <br /> 1 ' ' !7! Hl = <br /> X j'�L ll� '�a6 1n�5S reM y 4-sa�lh2r <br /> �� '� X30x.30 n ,+ <br /> 17 -G- <br /> ' T7 <br /> G- Y <br /> �� ,� �? Y -� IN rr �p <br /> Ip:0 -• � �. I n �� w c-fI� <br /> TOTALS )(7$: d 5 <br /> BALANCE DUE: 115(" <br /> BILLING DATE. <br /> EH 23 074 (Rev 3/22/91) <br /> -5- <br /> Cam v �,7s= /l <br />