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4 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT# <br /> COMPUTERRERMIT# s k <br /> SITUS/FACILITY ADDRESS: ov-//, <br /> DBA: <br /> BILL TO: <br /> PHONE: <br /> BILLING ADDRESS: <br /> CITY/STATE: <br /> ZIP: <br /> PROGRAM; TYPE OF SERVICE: <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HO <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TAS, UR, ANY ADDITIONAL INSPECTION TMIE IS COMPUTED TO TF1E <br /> WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> 8AM- 4:30PM-8AM/ <br /> 4:30PM WEEKENDS <br /> �4: ice'"fir-L. <br /> S -E- t4 D .3,'t s a (x <br /> tiece11V_ 0 ac <br /> P&r t. <br /> s //ll � /i✓ �— 3 <br /> y�o'f���c-� ; LT <br /> TOTALS <br /> BALANCE DUE: <br /> PETROLEUM SYSTEM SPEC' :.:STS <br /> BILLING DATE: Leak Monitoring' Service <br /> Precision Tank Testing <br /> S <br /> Construction <br /> EH 23 074 (Rev 3/22/91) STATION MAINTENANCE <br /> WAYNE BELKNAP <br /> General Eng. Contractor (916) 649-8955 <br /> Lic. No. A-631422 CA (800) 600-8955 <br /> R.E.A. - 02591 Pager (916) 951-8020 <br /> P.O. Box 245195 • Sacramento, CA 95824-5195 <br />