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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORI%'-SHEET <br /> UNIT # -JLI <br /> COMPUTER/PERMIT # [5C L IC) Liq <br /> SITUS/FACILITY ADDRESS: I o -1 C.(o, <br /> DBA: <br /> BILL TO: L s c PHONE: 15`16 <br /> BILLING ADDRESS: 0 <br /> CITY/STATE: c ca t o=^ C ZIP: <br /> PROGRAM: P '5®0 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. g2 <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SA?Vf- 4:30PNI-SAM/ <br /> SERVICE 4:30PNI WEEKENDS <br /> PIC-A <br /> f\5 Vfc- w <br /> - <br /> TOTALS <br /> Il,kLkNCE DUE: <br /> BILLING DivrE: <br /> EH 23 074 (Rev 3/22/91) <br />