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r <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # a�— c r� <br /> SITUS/FACILITY ADDRESS: <br /> DBA: •�'/ ✓ems✓ ��'�c��f' �® <br /> �rt/J!'F�C" / •�Y� - �� PHONE: <br /> BILL TO L <br /> BILLING ADDRESS:,Za o/ /1��9•P T -�7% <br /> CITY/STATE: c�.d�is�6� ZIP: <br /> PR0GRAIIM: = TYPE OF SERVICE: <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 SAKI- 4:30PNI-SAM/ <br /> SERVICE30PM N EKEN S <br /> �o <br /> � <br /> -, <br /> A . <br /> � <br /> TOTALS <br /> BALINCE DUE: y�6�! a <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br /> v <br />