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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # ru-- Q / 7�+ <br /> COMPUTERMERMIT # F3 a�� � V l b <br /> S(TUS/FACILITYADDRESS: <br /> DBA: <br /> I <br /> BILL TO: PHONE: <br /> BILLING ADDRESS: <br /> Cr Y/STrUTE: ZIP: <br /> PROGRAM: TYPE OF SERVICE: �T-0) VtP Gyf ALN-e- �10�YU u <br /> jS�� Cfi dvz <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 T2a- <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAZME <br /> of 3AIVI- 4:30PM-SAW <br /> SERVICE 4:30PNI WEEKENDS <br /> `.3i� O e <br /> c <br /> litiqu <br /> 6'6O- 10',34 D /l <br /> ff <br /> sw %oc� <br /> TOTALS <br /> BALUNCE DUE: <br /> BILLING D,UTG <br /> EH 23 074 (Rev 3/22/91) <br /> �� r e DRPf <br />