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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # .3 <br /> COMPUTER/PERMIT# SHA/!G Co d <br /> SITUS/FACILITY ADDRESS: Coo c n <br /> DBA: - _ vin-fir. Cie <br /> BILL TO: y/GAG, , // c1) S� PHONE Jy9 5�3,f/u0 <br /> BILLING ADDRESS: �U>v Sf G h L� /rJ✓C� yltiP <br /> CITY/STATE: 12?0c(P s hV U/ ZIP: its 35� <br /> PROGRAM TYPE OF SERVICE: Tien_ mon ��ir/p�gyPyi�w�inyPc/7w `el <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> 3L2 V"'co /02 (h o <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAKI- 4:30PIvi-3A.M/ <br /> SERVICE 430PM WEEKENDS <br /> N/ <br /> 5� :po 33a f N/ <br /> _- Ta iCJev�G� N/ <br /> OKe-11,..o �GnE ie.,w�al� <br /> /6/ a loflx� pv e. /U) <br /> (21, <br /> /u/ <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />