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ENVIRONMENTAL HEALTH DIVISION <br />ACCOUNTING WORKSHEET <br />UNIT # \ <br />(ivec.� SiLP s ux�� �S9 5// <br />COMPUTER/PERMIT # S/-9^XT0 <br />SITUS/FACILITY ADDRESS: /moi S <br />DBA: Stern Tr9G ���rn cocrnA, rO4rle- 46"cu-f <br />778 so <br />BILL TO: t%'0"In PS PHONE: y(oj - al n <br />BILLING ADDRESS: <br />CITY/STATE: <br />PROGRAM: TYPE OF SERVICE: <br />ZIP: <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 />D___ � u�cr.4) -z1T.L__-L__/_---&uvly <br />DATE <br />of <br />SERVICE <br />WEEKDAY <br />3ANI• <br />4:30PM <br />WEEKNIGHT <br />4:30PM-SAM/ <br />WEEKENDS <br />HOLIDAYS <br />DESCRIPTION OF WORK <br />REHS NAME <br />��Q <br />� <br />!�hE'vi<c✓ <br />/ <br />0 <br />7 7 10A- <br />) <br />2" <br />/W <br />f< <br />TOTALS <br />F / f ,v - I,A 1 1,10— <br />IIAL'kNCE DW <br />BILLING D;1TE: <br />EH 23 074 (Rev 3/22/91) <br />k <br />U 01. A <br />