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' ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # /.1 iMu L 77/ j f1,3 <br /> SITUS/FACILITY <br /> ADDRESS: 7 71-) L_� Gti �J6iC/itli <br /> DBA: Gl✓/ Y Q �� <br /> BILL TO: _ CGG PHONE: <br /> BILLING ADDRESS: 7 t� �' G}f GC f'�< / TC P A7yy? Rr <br /> CITY/STATE: ZIP: ?&7L) Jo <br /> PROGRAM: TYPE OF SERVICE: <br /> u 661 <br /> THE 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- 4:30PM-SAM/ <br /> SERVICE 430P\I WEEKENDS <br /> L /14' <br /> TOTALS / n <br /> BAL\NCE DUE: v" f / �n �S I• <br /> BILLING D,YCE: <br /> EH 23 074 (Rev 3/22/91) <br /> V <br />