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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # 3 <br /> COMPUTER/PERMIT # a s 7. <br /> SITUS/FACILITY ADDRESS: / 3 8s Coote er o�olr s �� <br /> DBA: Zren e P/u e- — <br /> BILL TO: .�. /2n Sey ✓r c P S ��v r PHONE: ql V43 23 <br /> BILLING ADDRESS: fan /j, Lli� rvv� S� <br /> CITY/STATE: 5-fo C/c Arrr? 09 ZIP: 4?S'Lo/ <br /> PROGRAM: e,1 T TYPE OF SERVICE: QPmy /t�a/uo, rP✓retJ. �hscec�rdii re <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE Cl) HOUR ANY ADDMONAL 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-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> O 7 <br /> lf�')/Y�4 u <br /> �l/ n G_ f�� 930A—/,231D 3. <br /> �clo�u e <br /> TOTALS <br /> BALANCE DUE: .sem 8. 117 <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />