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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # -TT <br /> COMPUTER/PERMIT # I <br /> SITUS/FACILITY ADDRESS: <br /> DBA: Q1yU��I,KN GLC� ( ' PZ L <br /> BILL TO: j {jx= (oj C� - Z q3 -- ,JS&� PHONE: <br /> /I7/ �/ <br /> BILLING ADDRESS: gl/C(i 56124-5 <br /> CITY/STATE: f �C �y1 ZIP: <br /> V <br /> PROGRAM: 1� TYPE OF SERVICE: ���1� gogy1/- <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED 0 THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATEWEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK RENS NAME <br /> of SAvl- 4:30PM-SAM/ <br /> SERVICE 4:30PM \VEEICENDS <br /> U � �q;� hovrireh <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DA'Z'E: <br /> EH 23 074 (Rev 3/22/91) <br />