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ENVIRONMENTAL HEALTH DIVISION <br /> ,L ACCOUNTING WORKSHEET <br /> UNIT# <br /> COMPUTER/PERMIT # !9 <br /> SITUS/FACILITY ADDRESS / roo La/. Lial�✓C �� 7 r j �� �3 <br /> DBA: \ 27_ / G� X5J01- <br /> BILL TO: PHONE <br /> BILLING ADDRESS: �/ <br /> CITY/STATE: D ZIP: `/ f /Vl <br /> PROGRAM: �G TYPE OF SERVICE: lej: -C d/ �Z C <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TINE IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR INCLUDING TRAVEL THAE. d (/ <br /> DATE WEEKDAY WEEKNIGHT HO IDAYS DESCRIPTION OF WORK REHS NAME <br /> of 8AM- 4:30PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> r/rn� <br /> -P I3i,7 119-iv ck, it ,/ / <br /> Z,z� y ' <br /> TOTALS <br /> BALUNICE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />