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6 0 <br />UNIT # <br />COMPUTER/PERMIT # IJQ13 <br />SITUS/FACILITY ADDRESS: <br />DBA: <br />BILL TO: 1 -co fi o /1) , 72L" n -f-, PHONE: <br />/J1 <br />SVILLING ADDRESS: 711 !d <br />) 4 ?? 1 6 ff) <br />0- <br />CITY/STATE: ZIP: <br />PROGRAM: e� 3, X TYPE OF SERVICE: /m <br />117 <br />�FHE 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 />kcoc e'l vei—S-1 � <br />DATE <br />of <br />SERVICE <br />WEEKDAY <br />Alyl- <br />4:30.NI <br />WEEkNIGHT <br />4:30PM-SAM/ <br />WEEKENDS <br />DESCRIPTION OF WORK <br />BikLkNCE DUE: cr <br />BILLING DATE: <br />EH 23 073 (Rev 3/22/91) <br />M <br />wm <br />