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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUN I G WORKSHEET <br /> UNLIT # -77//- <br /> co M?L"I•ER/PERmIT # <br /> SITUS/FACILITY/A�DDRRESS: <br /> DBA: cl9 N W C1 VIM � <br /> BU-L TO: �.IZ�nrctm "-? n�GLU L^VI. �( PHONE:z� ! ' / 7 7�o'S3�- <br /> BI LING ADDRESS: l�U } L � -125 Iv �- ��"^� <br /> crrYisTATE ZIP: —119 <br /> PROGRAM: U TYPE OF SERVICE: <br /> TES MINIMUM T4SE FOR EACH INSPECTION LS ONE (1) HOUR, ANY ADDMONAL INSPECTION TIME IS COMPUTn"D TO THE <br /> NE4R£ST HAIP (1/2 HOUR, INCLUDING TRAVEL TIINE. <br /> io zt� rz VJR� <br /> /• WEMMAY WEEKMGHT HOLIDAYS DESCRIYPION OF WORK REFS NAME <br /> SAM- 430PM-8ANV <br /> 430PM WEEKENDS <br /> I��tiN�v q•. o��o;� �),�• I��,-I rev�.c�.�o • P '�" �1,yn, Ny <br /> WOO- <br /> i2.3�2 Io�Is'ir•H5 � w, � ��,.�� b <br /> I22Z'g2 I:oo—It30 h !_ �12Cprhmn. aw. <br /> 12-2z X12 1:30-2:00 <br /> TOTALS <br /> BAL+-4CEDUE J ). <br /> BILI.IIVG DATE: <br /> EH 23 074 (Rev 3/22/91) <br />