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ENVIRONMENTAL HEALTH DIVISION <br /> ' ,/ ACCOUNTING WORKSHEET <br /> UNIT #�" <br /> COMPUTER/PERMIT # Scc�EN 5 b� �SGt/ � J <br /> SITUS/FACILITYADDRESS: 8gazQ,fnz,;n OLL- ('Iao�a d`c(a � <br /> DBA: /` <br /> BILL TO: �/�GGIlYI Tf�i,/ Ly�Q l/ PNON- 7r/OJ3 -7118 <br /> BILLING ADDRESS: � 7 (J (6c)x-. 257 <br /> CITY/STATE: 51-6 �3Y) �A ZIP: <br /> PROGRAM: 5-T- TYPE OF SERVICE: �PXVytuL <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREA HALF (1/2) HOUR, INCLUDING TRAVE E. <br /> ai ovr3 9 Wl"6 <br /> DATEWEEKDAY WEEKNIG T HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 3Ab1- 430PNI-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> 20 3y:3D hr >Q^^(D n lLr.�review o 4v a ffnwh to Nr <br /> I ZZ 9Z 83000 �y At[7 <br /> t 1 2 1�'•20� X S �p w rFrVna.vv,L rs.n..ev.�. <br /> 9 I + s /1 /� V <br /> 1a �j2 gC3D I BILA- rile u rarrava2 /GO P <br /> toRZ '. oC �I.V Abu +�4p cnA- <br /> w / I <br /> plee <br /> TOTALS1 S / 17 <br /> � 7jll <br /> B,\LANCE DUE: ` ' / <br /> 711 <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br /> %w <br />