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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNI IT <br /> COMPUTERIPER.NfIT # <br /> SITUS/FACILITY ADDRESS: -5 E. `4 Pta� <br /> Jl r <br /> DBA: <br /> BILL TO: F. Mc PHONE: (ad <br /> BILLING ADDRESS: l/3 I LL), L412i-czL <br /> CITY/STATE: I ►` 1 ) J-e sin C (4 ZIP: 2E3 5-1 <br /> PROGRAM: G ,� TYPE OF SERVICE: <br /> THE MINIMUM TWE FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDMONAL INSPECTION TIME IS COMPUTED TO IHE <br /> NEAREST HALcr(1/2) HOUR, INCLUDING TIRA, EL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS N.1,NlE <br /> at SAM- 4:30P.I-3A:NI/ <br /> SERVICE 4:30P��I 14EEX-E DS i <br /> —6- ig. <br /> 3:0o--3:30 <br /> I. hilII <. <br /> 9, 1 <br /> 3:D0— 31. 15 c cLt& <br /> -Lev, mil <br /> zV <br /> 11 -So�t ` <br /> P v V1 j A,4 /-/1 <br /> - <br /> I <br /> TOTALS <br /> BAL1NCC DUE: <br /> BILLING <br /> D,\I r: <br /> EH 23 074 (Rev 3/22/91) <br />