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t ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> CONIPUTER/PERMIT # L <br /> SITUS/FACILITY ADDRESS: III <br /> —G+ /V• l � \ G (-r, <br /> DBA: `t Gc C l/ / <br /> BILL TO: V <br /> BILLING ADDRESS: <br /> CITY/STATE: ZIP::J <br /> PROGRAM: 3 ' `, y TYPE OF SERVICE: r � / fX /�IQ/1I I�✓teC d�1i1SLK 7/ifJ. <br /> THE MINIMUM TIME FOR EACH LNSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECIION TIME IS COMPUTED TO THE <br /> NE?REST HALF (1/2) HOUR INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NALME <br /> of 3ANI- 4:30P vi-SANT/ <br /> SERVICE 4:30PM WEEKENDS ^� <br /> sSu/u= tQAeLm, 'sem u 1 <br /> 3 _ <br /> roTALs � �,/ �/�I/ •�'� <br /> BALANCE DUE. <br /> BILLING DATE: <br /> EF. 23 074 (Rev 3/22/91) <br />