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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # .- <br /> COMPUTERRERMIT # <br /> SITUSIFACILITY ADDRESS: l t 1rJ�(� \Aj c I q � � I <br /> DBA: Ktna T�i /anC Uc-:orr � \ q ) <br /> BILL TO: Vele + l�m-J Y U Ch ( o-y-� PHON <br /> BILLING ADDRESS: P •0 - 6 b X l U o 3 <br /> CITYISTATE: Lob C (\ n ZIP: (qjz y l <br /> PROGRAM: U ST TYPE OF SERVICE: rp-/Mc)ya <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR ANY ADDITIONAL INSPECTION ME IS COMPUTED TO THE <br /> NEAREST HALF /2) JJOUR, c <br /> LUDING TRAVEL TQNE <br /> ? /S 51-24110p �l <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PM-3AM/ <br /> SERVICE 430P:YI WEEKENDS <br /> 10;00 - re h ra re Lc \ , Air <br /> � <br /> � yl 12 : Oo iC lan- Llsrdf �Scn lb�z� <br /> g.00-, �cmpPe.ied rev ¢ <br /> 6 19 I 8 30 <br /> 7 �n dv s u d rn tv <br /> g2 '1100 c) t)1i Removes c4- 4a✓nk- ( y Ul6(J <br /> CpJ2r ( r n N r <br /> TOTALS 5 <br /> IiAlkNCE DUE: � ';t' ✓ <br /> BILLING DATE <br /> EH 23 074 (Rev 3/91) <br />