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ENVIRONtiIENTAL HEALTH DIVISION <br /> ACCOUNTING WORK-SHEET <br /> ULNIT # j71 <br /> CONIFUTERIPERMIT # eTr+ <br /> SITUS/FACILITY ADDRESS: <br /> DBA: C a <br /> BILL TO: PHONE: <br /> BILLING ADDRESS: <br /> CIT`t'IST4-\TE: ZIP: <br /> PROGRAM: )7- =1 E OF SERVICE: <br /> TF:c MINIMUM TIME FOR EACH INS?ECTION IS ONE (1) DOUR, ANY ADDITIONAL INSPECTION TD4-z IS COMP=E-D TO THE <br /> N ST (1/2) FOUR, INCLUDING TRAVEL TL'vtE. <br /> I DATE WEEKDAY WEEKINIGHT HOLIDAYS DESCRIPTION OF WORK RENS NAME <br /> of SAM- 4:30P1rI-3A.Nf/ <br /> SERVICE 4:30F.M %V'EEKE"NDS <br /> izy <br /> fj �Gj 5'OO ' 3D l) lie utae.� n -rLMci <br /> c4nuic� <br /> Z.cr�N I ,7 trk.5?&A-Ccr 40e ups <br /> ! I <br /> I <br /> TOTALS <br /> BALkNCE DUE: <br /> BILLING D,vrE: <br /> EH 23 074 (Rev 3/22/91) <br />