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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # 3 <br /> COMPUTER/PERMIT # /y a 5- <br /> SITUS/FACILITY ADDRESS: <br /> DBA: <br /> BILL TO: /e/ PHONE: <br /> BILLING ADDRESS: V3,2 w . Ce, l4et <br /> CITY/STATE: r/_9 ZIP: 93"3 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 WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PM-3AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> TOTALS <br /> BALANCE DUE: S CSU <br /> BILLING DATE. <br /> EH 23 074 (Rev 3/91) <br />