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ENVIRONMENTAL HEALTH DIVISION <br /> l v ACCOUNTING WORKSHEET <br /> UNIT # ._ <br /> COMPUTER/PERMIT # � <br /> SITUS/FACILITY ADDRESS: S I,:F / <br /> DBA: <br /> BILL TO: PHONE: <br /> BILLING ADDRESS: � <br /> CITY/STATE: �I vJ ', ZIP: /9 S3 <br /> rE—,moi/ ,p0y/eo.i .1 �!c A" <br /> PROGRAM: TYPE OF SERVICE: <br /> THE MINIMUM THa FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR INCLUDING TRAVEL TIME. e /1�j <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 8AM- 4:30PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> V/U°4`� IVA ` /11 •% / /Z <br /> TOTALS <br /> BALWCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />