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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # /� <br /> COMPUTER/PERbIIT # T <br /> SITUS/FACILITY ADDRESS: 7S W GOWELCi s/+�/�i <br /> DBA: 7441-� TdINT L/!V/ON 11 II6N � dD� /S <br /> BILL TO: �NENY�U FA2 A�NZknl — t I1 LCi R� PHONE: <br /> BILLING ADDRESS: - �-��0 N • /'r)1j <br /> CITY/STATE: ' I In I►�i.2. [i1k / " " ZIP: <br /> PROGRAM: L2k' z TYPE OF SERVICE: !f�S� G„rsLiVA) 4wlew ®wl7a+�S <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIMEfE 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 SAKI- 4:30PNI-SAKI/ <br /> SERVICE 4:30PbI WEEKENDS <br /> TOTALS <br /> BALUNCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br /> V �. <br />