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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> i <br /> UNIT # <br /> COMPUTER/PERMIT # <br /> SITUS/FACILITY ADDRESS: S!(9 /;2 ren v A« <br /> DBA: S a k--fu » 1-)P✓C war. ,..✓a CfAv <br /> BILL TO: MA VVk a I Vt-c h a vic e- :_ PHONE �c�S"9aR R18� <br /> BILLING ADDRESS: <br /> CITY/STATE: C 'a t 4 u VVL a ill ca ZIP: <br /> PROGRAM: 0(of ?k51rµo TYPE OF SERVICE: Q /AIN v ev tew T l m (ti s� lla�to ns <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL. INSPECTION TDAF 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/ <br /> SERVICE 4:30PIvi WEEKENDS <br /> 7 1,k fd- 7 3a <br /> 7-/-3Al - 3 30 l re w ew � AO <br /> Fill-7 lqZ ye L, e-w g Am"ca NR <br /> l C' Nn <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br /> I <br /> i <br />