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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # ; I <br /> COMPUTER/PERMIT # Awt�O (D- <br /> SITUS/FACILITY <br /> a-SITUS/FACILITY ADDRESS: 1210 c l N(•-yzp G� q �F �j <br /> DBA: ak ?-y)Ro CHey hf -i / <br /> BILL TO: L�I �T l/�-`po s - {pQ 1! ^nlCr �C � 'IAC PHONEi�llo� <br /> BILLING ADDRESS: �O ���. rz��' <br /> CITY/STATE: I_i QC C)l -t,)) Cf� /ZIP: q 5(Dq <br /> PROGRAM: TYPE OF SERVICE: Rr-yU�d�t tJSpCC II C ( `o 1,,A ar, <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TALE 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-3AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> 7-7 <br /> TOTALS <br /> ItA1 INCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />