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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # _� UjwB(//7 <br /> COMPUTER/PERMIT # J I Y6 <br /> SITUS/FACILITY ADDRESS: 1 -1 I-f/�O j4Z LA�/J Ai/e �8��7✓1� } /57t24 <br /> DBA: �lAr1 gUSKl Qk (9'b <br /> BILL TO: Tn — l'..e¢.rxe O i L PHONE: <br /> BILLING ADDRESS: — P, O Bo)C 3SrT Dl� 6,0'L— <br /> CITY/STATE: i ZIP: `? !52-V1-07J_7 <br /> PROGRAM: V 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 TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 430PM-SAM/ <br /> SERVICE 4:30PNI WEEKENDS <br /> - U c <br /> I <br /> TOTALS <br /> 13ALkNCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />