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0 ok <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT# S k O 0 6*loa `b 17 FA 1 <br /> SITUS/FACILI1TY ADDRESS: 3 <br /> DBA: >"1 Q QQ/lm a j1vi a �hB ( �D(Yi7�4�U I VI r J R7L( L <br /> BILL TO: <br /> Pi l e I le a 1 3Yl Q/ it s PHONif 91 fo ly-0 6 <br /> BILLING ADDRESS: II /& o 9 � ��G h I e4,),,b u_qt¢/ <br /> CITY/STATE: Ltn Q (Z iq IP: 6a ye b <br /> PROGRAM: 02 3 'WD -TYPE Ll(��TYPE OF SERVICE: 7iyl ,) <br /> fila, ,S /Pzct7, oyl--, , <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDMONAL INSPECTION TIME IS COWUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> WEEKDAY WEEKNIGHT HOLIDAYS DESCRIP'T'ION OF WORK REHS NAME <br /> 8AM- 4:30PM-8AM/ <br /> p 4 4:30PM WEEKENDS <br /> O" I ?11' 30f9 .3o <br /> 'L p wf tAu C6,'1 ! 'vi s <br /> uv <br /> :06 -,�;oo <br /> ti`f a <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE <br /> EH 23 074 (Rev 3/22/91) <br />