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t <br /> y.` <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> COMPUTER/PERMIT <br /> t �5-1,,�r r f <br /> SITUSIFAC[LITY ADDRESS. )lUoo r I� )�' L 14OLLE)LO e0l', <br /> DBA' '� �, t 1C � -•,� �' <br /> BILL TO: r c PHONE: <br /> BILLING ADDRESS: <br /> C[TYISTATE: rr - ZIP: .9'>`I�2S <br /> PROGR,uVL 'i TYPE OF SERVICE: r C-611 <br /> L3- <br /> THE WNIMUj l TIME FOR EACH INSPECTION IS ONE Cl) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR. INCLUDING TRAVEL TIME. 'b �fC��� IA 113 F-bO' (-A-) <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 3AM_ 4:30PM-3AM/ <br /> SERVICE 4:30PNI WEEKENDS <br /> �. � r �! � ✓IJP C� <br /> • j��{ � yrpr�/�Nt�.rC� c <br /> r_s-L/z;� ��nk �t22ffC+han <br /> OF <br /> lee» r 5e <br /> hcr3L ,vCrStlens w,#h: <br /> , c/30 <br /> $�rk� w�bMl FN��vcb 7l+l�cE a� <br /> W oeo� <br /> I S 7i9 �C S �.✓ <br /> 3711 <br /> �, r <br /> TOTALS <br /> IlA1.ANCI: DUE: <br /> BILLING IDATE: <br /> EH 23 074 (Rev 3/91) <br /> 4 <br /> 14Uf <br />