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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # 10 j <br /> SITUS/FACILITY ADDRESS: Ql /p)V c�` r 36 G <br /> DBA: ':j-'d" '-�. <br /> BILL TO: i PHONE. `�1(a (oY(v-(P7r eL <br /> BILLING ADDRESS: <br /> CITY/STATE: ZIP: <br /> PROGRAM: TYPE OF SERVICE: r d <br /> 61 <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL II SPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> /59s v p - ja� = <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> CEO <br /> 10,3o-Ya �0:'T- i. q.5 <br /> TOTALS �f <br /> BALANCE DUE: <br /> BILLING DATE: j?. C • <br /> EH 23 074 (Rev 3/22/91) <br />