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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTERIPERMIT # QDLQ S / 9 0?ccy g CJ <br /> SITUS/FACILITY ADDRESS: Std C-A 4_&� <br /> DBA: <br /> B[LLTO: PHONE: <br /> BILLING ADDRESS: <br /> CITY/STATE: � ( �� c� f' cc r l 1 ZIP: <br /> PROGRAM: u -TYPE OF SERVICE: C SGUr_eTHE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 430PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> -a- <br /> 3130 — JV_u4ZW �C2osc�e <br /> 8: 30,— /s <br /> ot;DO' — I X s <br /> I:oQ- (a;3o ' U44L.hP/N2Uv'a Q <br /> i <br /> TOTALS <br /> MALINCE DUE: <br /> MILLING DiVrE: <br /> EH 23 074 (Rev 3/22/91) <br />