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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # . <br /> COMPUTER/PERMIT # l4 <br /> SITUS/FACILITY ADDRESS: — y�( �D X S. K—� <br /> DBA: / "I. i�/��� �(� / ( i l �G S7i3 f <br /> BILL TO: A4o p PHONE: <br /> BILLING ADDRESS: U. • l3o ZL37 <br /> 3 <br /> CITY/STATE: (G -- ZIP: <br /> PROGRAM: I� TYPE OF SERVICE: <br /> 5ai <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL.TIME. <br /> 3ffi <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> TOTALS <br /> RALUNCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />