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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # r f <br /> SITUS/FACILITY ADDRESS: Gp�✓� <br /> DBA: . _ -fU1I Z,:21 T- L�,2^ 9 c szsl tS7 r� <br /> BILL TO: -14 F M -Z ' ! :� PHONE: <br /> BILLING ADDRESS: r N a � <br /> CITY/STATE: d.1 f ` i �f� _ ZIP: 2� <br /> PROGRAM: V TYPE OF SERVICE: r y '4 AtA-f"Aq <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 RENS NAME <br /> of SAM- 4:30PM-SA2vS/ <br /> SERVICE4:30PM WEEKENDS <br /> TOTALS <br /> BAIANC E DUE: ' <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />