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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # c <br /> COMPUTER/PERMIT # S DC K .5J�/f� <br /> SITUS/FACILITY ADDRESS: t J / D,�n L / Y 1 a ry ��p � <br /> DBA: S fr�G if 7� [SLP/L�I��-'l' !/itP��ilJGt-C'� d-." �1-//1J - <br /> BILL TO: PHONE: <br /> BILLING ADDRESS: <br /> CITY/STATE: 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 IJ <br /> NEAREST HALF (1/2) HOUR, IN LUODING TRAVEL TIME. <br /> DATE WEEKDAY W KNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 8AM- 4:30PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS 64na .� <br /> - 3- of <br /> 3/-�1 't•cb-4's30 <br /> w � <br /> b'16-q1 /l. '. 0 <br /> 4-a3-41 <br /> I9a- oo- <br /> TOTALS <br /> BALANCE DUE: J(J <br /> 13ILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />