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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # r <br /> COMPUTER/PERMIT # LN/L S /`/ /54-5' <br /> SITUS/FACILITY ADDRESS: <br /> DBA: <br /> BILI. TO: _ wrf_q �e��i'/c % XCavc PHONE: "S--7b 7% <br /> BILLING ADDRESS: _-- 1 Ll 0!5 Co.1 i-�wr rl I e, <br /> CITY/STATE: ZIP: _�5 3 Zd <br /> PROGRAM: TYPE OF SERVICE: <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- 4:30PYI-SAM/ <br /> SERVICE 4:30PI44 WEEKENDS <br /> 0. <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DA'L'E: <br /> EH 23 074 (Rev 3/22/91) <br />