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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT `O,p•Em 6y <br /> COMPUTERNERMIT# 1 7 v <br /> STTUS/FACILITY ADDRESS: <br /> • <br /> DBA: r sf L7ri <br /> BILL TO: <br /> BILLING ADDRESS: <br /> 2 / A-,• 4f/n,� S f �• C . Y��� �l,a� <br /> CITY/STATE: S <br /> ZIP: 9f-,)uz <br /> PROGRAM: �r 5� TYPE OF SERVICE: %J3/t� oi/zvivt✓C�l <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR AINY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> 'L34 -d� <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 3Abl- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> v( <br /> I � U /� scr •n <br /> Phi_i�'; •� /" S I <br /> I <br /> TOTALS <br /> BAL\NCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />