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y <br /> ..r <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> CONIPUTER/PERMIT # c�,f)ED� <br /> SITUS/FACILITY ADDRESS: /A) %(),e A 1F� KOf�DT r Z/ <br /> DBA: ,/(,/r / <br /> BILL TO: SL %icQ sh?-6n,n <br /> BILLING ADDRESS: 5-9 <br /> CITY/STATE: .S fZY�c C'/� ZIP: <br /> PROGRAM: TYPE OF SERVICE: <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/ � i" <br /> SERVICE 4:30PM WEEKENDS dill <br /> �, aid �' <br /> 5_S30 �, 2 <br /> - so <br /> - <br /> -z-ql <br /> SiA/m 42 <br /> -//30 z e <br /> TOTALS <br /> BALINCE DUE <br /> ,::�3 X <br /> BILLING DATE: 7g — <br /> EH 23 074 (Rev 3/91) <br />