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0 0 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # OC A� I 1 111&5 <br /> SITUS/FACILITY ADDRESS: J`/0 <br /> 1SS: <br /> DBA: SSD c,(&e'v LI�,fCe /�3f/VfDiL/iD�� l0/st�L(�J <br /> BILL TO: <br /> PHONE: <br /> BILLING ADDRESS: <br /> CITY/STATE: ZIP. <br /> PROGRAM: �[ G S TYPE OF SERVICE: <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIM4 is COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> D <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of 8AM- 4:30PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> a�-Yr <br /> 3 a8-41 <br /> "'Do-3• ,�,,�e,J etow• <br /> 15 R;oo ko-�2 c u <br /> rads <br /> 46 uJ <br /> Vl- <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />