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ENVIRONMENTAL HEAL'T'H DIVISION <br />ACCOUNTING WORKSHEET <br />UNIT # g /7 <br />COMPUTERIPERMIT # IV Zr <br />1_' <br />US/FACILITY ADDRESS: <br />- l Lfll <br />` PHONE: <br />BELL TO: <br />BELLING ADDRESS: <br />ZE? <br />//' . <br />ClTY/STATE: 11 Ct <br />TLY <br />PROGRAM: V TYPE OF SERVICE: <br />THE NuNRviUM TME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TI:IvIE IS COMPUTED TO THE <br />NSAREVJ-A Al/2) HAURrINCLUDU499 IAV TUa ' <br />BALANCE DUE: <br />BILLING DATE' <br />EH 23 074 (Rev 3/22/91) <br />WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br />4:30PM-8AM/ <br />WEEKENDS <br />WEEKDAY <br />} , <br />$AM- <br />r� <br />4:30PM <br />j[�f ' <br />f •V L�VV <br />Sb Mll1 <br />l�2 �� <br />fo•,o{� — 16, 2 - <br />aa <br />v'��J`�j <br />.v.iw <br />`x•30, ya:o <br />BALANCE DUE: <br />BILLING DATE' <br />EH 23 074 (Rev 3/22/91) <br />WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br />4:30PM-8AM/ <br />WEEKENDS <br />