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N � <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # LLJ-" n <br /> CONIPUTER/PERMIT # Ll' <br /> DBA:SITUS/FACILITY ADDRESS: s <br /> DBA: <br /> BILL TO: �. jYJ2J PHONE: (90� 91f L--w$ <br /> BILLING ADDRESS: /p, �/� , �y� 7,3 ? <br /> ,3 �y <br /> d <br /> CITY/STATE: � yG! 17YL� l f4 ZIP: S7n 1 <br /> PROGRAM: N I TYPE OF SERVICE: d- <br /> GYiS2C 7172�91� <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTI N TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEIvNIGHT HOLIDAYS DESCRIPTION OF WORK REHS N.4�fE <br /> of SAN[- 4:30P M/ <br /> vte /9 <br /> SERVICE 430PNI WEEKENDS <br /> r <br /> 3 /� /D:oo-/D:3o N �&VLd ?GP��/P/t) E.T. <br /> n Fb: 3flh ll,o u, <br /> c C� 2a �ev iruJ T <br /> a R /l:oDasn-1� <br /> Ps 30 �5 c`he-. s <br /> T/.4�7J/i'JcLmttvc� 2� C <br /> I�. <br /> � <br /> TOTALS <br /> ��e'�f <br /> B,. L,INCE DUE: , <br /> BILLING llA'1'E: <br /> EH 23 074 (Rev 3/22/91) <br /> i <br />