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ENVIRONMENTAL HEALTH DIVISION <br />ACCOUNTING WORKSHEET <br />UNIT # � 3 <br />COMA R/PERMIT # --km j n ?C), -Is <br />SITUS/FACILITY ADDRESS: <br />Em <br />BILL TO: �_d_)FgT2I.1 ��FT�� PHONE•(ZCA) 94� <br />BILLING ADDRESS: Zz,�?,s jPe Ve S >,�v <br />CITY/STATE: PY �C tZ�n (�O. ZIP: qS20 <br />PROGRAM: ()nFS-7 TYPE OF SERVICE: <br />THE NM4 4IUM TAE FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION T a IS COMPUTED TO THE <br />NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br />DATE <br />of <br />SERVICE <br />WEEKDAY <br />SAM- <br />4:30PM <br />WEEKNIGHT <br />4:30PM-SAM/ <br />WEEKENDS <br />HOLIDAYS <br />DESCRIPTION OF WORK <br />REHS NAME <br />5 3 <br />iD-Ins <br />o <br />n <br />�a <br />30ba <br />0 <br />TOTALS <br />BAIJkNCE DUE: <br />BILLING DATE-- <br />EH <br />ATE: <br />EH 23 074 (Rev 3/91) <br />