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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> CONIPUTER/PERMIT # Z-1 <br /> SITUS/FACILITY ADDRESS: /� �(�r /`� L/,� / _! �✓�r / �(��� <br /> DBA: U57 SCO a VST/0,4,, V lf_F <br /> BILL TO: ��_ iL/C U PHONE: <br /> BILLING ADDRESS: tu- <br /> CITY/STATE: /`11�201F ZIP: <br /> PROGRAM: L � TYPE OF SERVICE: �i4l�lK THE MINIMUM 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 NAIME <br /> of SAM- 4:30PNI-SA:I1/ <br /> SERVICE 4:30PM WEEKENDS <br /> (11'61/07 X00 . <br /> Kh <br /> Cl ;�41 Wi kT✓ 1 i G ( (S�/cL <br /> TOTALS <br /> IIALINCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />