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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # AMER 10 1 <br /> FSLO /vZ <br /> SITUS/FACILITY ADDRESS: <br /> DBA: <br /> BILL TO: PHONE: Com//(,,�.3(a q <br /> BILLING ADDRESS: 93 00 -FO2 c loo p <br /> CITY/STATE: / ,V `�Gl\TPY I C114 ZIP: (Sa <br /> PROGRAM: TYPE OF SERVICE: / U Q. �` pe -e- <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 /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 8AM- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> pd • `i—�C-4 � 1� : 0 -11;1 Ca,.P.F. p �•vko-eu.. �� �2PS c.�, <br /> r2 5-11.-41 Fol l/&tAl 4.�°tS <br /> i 1; is- 6 > �-- IVV— 1-, 6,5 <br /> 0 0 <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br /> v <br /> No/ �I <br />