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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT# <br /> COMPUTER/PERMIT <br /> SITUS/FACILITY ADDRESS:: 5Aglq F-!5 7 <br /> DBA: _ ElpsR NP9� ( K�t�-CS-cW6j SZ�N <br /> BILL TO: <br /> BILLING ADDRESS: 1 19 —I S -desk o 2 <br /> CITY/STATE: -�7TOck-rJ tj , 6- y� ZIP: 9 �� <br /> PROGRAM: UST TYPE OF SERVICE: <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 N(C 1 � <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> TOTALS <br /> BAL,0CE DUE <br /> BILLING DATE <br /> EH 23 074 (Rev 3/91) <br />