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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT #, /L <br /> CONIPUTER/PER;-MIT # _ STDG <br /> SfTUS/FACILITY ADDRESS: <br /> DBA: STy �+�oi'zoriu� <br /> BILL TO: Y <br /> BILLING ADDRESS: Z3�j7` PHONE Zo<< Gy/�� <br /> - - c <br /> CITY/STATE: ��/ <br /> PROGRAM: v� ZIP: ZZv <br /> -�`r�'�L TYPE OF SERVICE: <br /> THE MINIMUM ME FOR EI INSPECTION IS ONE (1) HOUR hYY AODM ONAi INS?ECTION <br /> NE.-1R ST KkE: (1/2) HOUR, INCLUDING TRAVE TIME. TIME IS CONIPUTZI) To rr.rr- <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS <br /> of 3ANI- 4:30PNf-3A&. f/of OF WORK REHS NA,\fE I <br /> SERVICE 4:30PNf WEEKENDS <br /> __ II i <br /> Z !� ' EGF v l 9 Fne <br /> L I <br /> ,00- <br /> i <br /> I <br /> I I <br /> I I <br /> TOTALS <br /> MLINCE DUI;: <br /> MILLING D,\1'E <br /> ------------- <br /> EH 23 074 (Rev 3/22/91) <br />