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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UVIT i* <br /> CO,'YfP=E_R/PERMIT +v/4- / <br /> SITUS/FACILITY ADDRESS. z 1�.Z 3 s— ("a roll. eel 571eekhw C <br /> DBA: R4�.�C �C10N <br /> BILL TO: �o� E.�a U, _ PHONE: X209 -�I63 -7/dam <br /> BILLING ADDRESS: . Po, ;gam /;Z57 <br /> CITY/STATE: c.4 ,- ZIP: gS,Zd/ <br /> PROOPL-MM: TYPE OF SERvICc: seal sero•✓ Soy/ �r ,o1r.�rA adsPr�rf1��v <br /> Trw �IINI�lMUi I TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION T52 IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING "TRAVEL TIME. <br /> DATE WEEKDAY WEEXCNIGHT HOLMAYS DESCRIPTION OF WORT{ REHS I`IAME <br /> of SAjM- 4:30P.1vI-SAM/ <br /> SERVICE 4:30PNI WEEMNDS <br /> a/q,?f _,t:3a _17";/ I;r w C; ! N <br /> /2:3a <br /> � I ' <br /> TOTALS <br /> 3ALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />