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ENVIRONMENTAL HEALTH DIVISION <br /> AC, COUNTING WORKSHEET <br /> UNIT # =F �/V <br /> COMPUTER/PERMIT # S Z 00 <br /> SITUS/FACILITY ADDRESS: �� V W <br /> DBA: G +lvT(,,,✓E i As <br /> BILL TO: IN �T�t PHONE: <br /> BILLING ADDRESS: <br /> CITY/STATE: / ZIP: <br /> PROGRAM: I11'r-5r TYPE OF SERVICE: I—I/1/e T�� ✓GA t� �/7NiC K Z <br /> THE MINIMUM 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 WEEKNIGHT HOLIDAYS DESCRIPTION Or WORK REHS NAME <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 430PM WEEKENDS <br /> L"nn"i <br /> 7A-,LJ P-e V i IAIA L 21� <br /> L J / <br /> i <br /> i <br /> TOTALS <br /> BAL,INCE DUE: <br /> BILLING DATE': <br /> EH 23 074 (Rev 3/22/91) <br />