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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> uNrr # <br /> COMPUTER/PERMIT # <br /> SrrUS/FACILrrY ADDRESS: % 5/Z, 0 // <br /> DBA \l B (,C,n W l Jc t�I G ffT S7i/SiM s ANG <br /> BILL TO: FMS PHONE: <br /> BILLING ADDRESS: �� i7 ✓ / <br /> Cr1Y/STATE r\—A") oQP/ ZIP: 3�n� <br /> PROGRAM: U�� TYPE OF SERVICE. <br /> THE WN2" TUE FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDMONAL INSPECTION ME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIDE. �� / <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK RENS NAME <br /> of 8AM- 430PM- AM/ <br /> SERVICE 430PM WEEKEYDS <br /> -[ -6 <br /> TOTALS <br /> BALUNCE DUE <br /> BILLING DATE <br /> EH 23 074 (Rev 3/91) <br />