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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # 3 <br /> COMPUTER/PERMIT # //,S'A <br /> SITUS/FACILITY ADDRESS: _ //Y7 G �l7in{�r <br /> DBA: �. l�/ossc� tr <br /> BILL TO: Thome PHONE ell YS� <br /> BILLING ADDRESS: <br /> CITY/STATE: Lo 41, ZIP: 5`Sa rr o}sj <br /> PROGRAM: G-i_ TYPE OF SERVICE: i an E s Pim Gv�Q�� ) - <br /> THE MINIMUM TOME FOR EACH INSPECTION IS ONE (1) HOUR ANY ADDITIONAL INSPECTION TWE IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION )F WORK REHS NAME <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 430PbI /� WEEKENDS <br /> GU yc (20 <br /> TOTALS <br /> i <br /> BALANCE DUE: <br /> BILLING DATE j <br /> EH 23 074 (Rev 3/91) <br />