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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # 3z <br /> COMPUTER/PERMIT # M h� r-5 <br /> SITUSjFACILITY ADDRESS: <br /> DBA: m [L� Y)Atf <br /> BILL TO: jTitT£/1//Q E E X(� y�l lTy �JG PHONE <br /> BILLING ADDRESS: O J Frls FTl CITY/STATE: F}�P�Of� t) �_ <br /> 1 I ZIP: 9 37Z <br /> PROGRAM: _U G"T TYPE OF SERVICE: u -'.T <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-3P W <br /> SERVICE 4:30PM WEEKENDS <br /> roTALs <br /> IIAL%NCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />