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ENVIRONMENTAL HEALTH DIVISION <br />ACCOUNTING WORKSHEET <br />UNIT # \5 /� � (iU <br />COMPUTER/PERMIT # l ' �P> �G V U - f# /* <br />SITUS/FACILITY ADDRESS: 1' O too ntrrW C I ULA -Bh fd 5-tni,� <br />DBA: <br />BILL TO: ���GIi`�D 1�77�UG/ lD� PHONE4��J���J7� <br />BILLING ADDRESS: <br />CITY/STATE: 0a an ZIP: ggb()3 <br />PROGRAM: �_) 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 <br />of <br />SERVICE <br />WEEKDAY <br />8AM- <br />4:30PM <br />WEEKNIGHT <br />4:30PM-8AM/ <br />WEEKENDS <br />HOLIDAYS <br />DESCRIPTION OF WORK <br />REHS NAME <br />-777', � <br />trlr�-17. �liuq <br />0 <br />h lir 4doe, <br />10 <br />23 ; /!? {eS'f �L <br />/ !� <br />%CGi�ii li��4 <br />515 Iq�I <br />ious- <br />it Ll <br />PPIP�ll iunKS#g-(u <br />ql l <br />(°' '-( 5 y <br />� <br />2° � �I �"� �-av�Ksw 8 -►u <br />l q/ <br />TOTALS <br />13ALANCE DUE: <br />BILLING DATE: <br />EH 23 074 (Rev 3/91) <br />