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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTNG WORKSHEET <br /> UNIT <br /> COMPUTER/PER.VIIT # a a Y3 <br /> SITUS/FACILITY ADDRESS: 3v <br /> DBA iQ•�o. - /fes Lr</ Sr� oil�sL �f <br /> i <br /> BILL TO: PHONE: <br /> BILLING ADDRESS: <br /> CITYISTATE: s/9 ZIP: s <br /> PROGRAM: (Ic7/S;OySl�•i< TYPE OF SERVICE: _- -��� ��-��✓ �. E �� ��u� <br /> THE XNIMUM 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 WEE GYIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 430PM-3A�VU <br /> SER VICE 430PM WcE NDS nn <br /> / S <br /> ✓-e ifresin a �.Guf� I NJL <br /> I <br /> TOTALS <br /> BAIANCE DUE: <br /> BILLLYG DATE <br /> EH 23 074 (Rev 3/91) <br />