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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # W <br /> CON(?UTER/PER:dIT <br /> SCCUS/FACILITY ADDRESS: <br /> DBA: yrAae / <br /> BILL TO: T/�1 C�'� <br /> � 3r1 I : <br /> /n� <br /> BILLING ADDRESS: Po IJC�X 126 <br /> CrNISTATE: c l \S[7 Il in ZIP: 32 72 <br /> PROGRAM: 2 b v TYPE OF SERVICE: � emDoa ( PIG 11 <br /> THE MINIMUM TME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION T+ME IS COMPUTED TO rrE <br /> NE9.4EST HAL_ (1/2) HOUR, INCLUDING TRAVEL MfE. <br /> 9 . <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NA.yfE <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 4:30PM NVEE:CENDS i <br /> -�- z $73t�/0•' <br /> 3-3-Q2 I 2:-,. 00 <br /> -�iZ =3o-a' 3J �xth14 ins c n V 1 <br /> TOTALS <br /> BALINCE DUE: 5. S rs 1� 53.00 <br /> BILLING DATr <br /> EH 23 074 (Rev 3/22/91) <br />