Laserfiche WebLink
ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # < <br /> CONIPUTER/PERNIIT # C d S <br /> SITUS/FACILITY ADDRESS: ol S 1��•�� I/�'�G �'� <br /> DBA: �Y c �C�f' / ✓'c. s <br /> BILL TO: DoX c �c �crc �e�wl PHONE: <br /> BILLING ADDRESS: cl <br /> CITY/STATE: S� } °� �`� ZIP: 9 53 6g <br /> PROGRAM: TYPE OF SERVICE: �� � �sLoect-t c. <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 SAM- 4:30PNI-SAM/ <br /> SERVICE 4:30PIN4 WEEKENDS <br /> 4-1L- � a'aa-3'•o� t�e� � � a����� Nr� <br /> I <br /> I <br /> TOTALS <br /> n <br /> B,, LANCE DUE: I 7 <br /> BILLING IMTE: <br /> EH 23 074 (Rev 3/22/91) <br />