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' ENVIRONMENTAL HEALTH DIVISION <br /> _ACCOUNTING WORKSHEET <br /> UNIT / <br /> MNIPUTER/PER�MIT <br /> SITUS/FAC[LITY ADDRESS: ��U <br /> DBA: , <br /> BILL TO: 4- !�` ,�' �' a1 �1/f Cam PHONE:(cf )QZ$�lSf ql <br /> BILLING ADDRESS: <br /> CITY/STATE: 5% /Tp / SIF; <br /> PROGRAIM: .I— TYRE OF SERVICE: ` i lli/ ✓�©VIOZ- <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (I) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, LL`(CLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK RENS NAME <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 4:30PVI WEEKENDS <br /> �WO G:Ev /►��.liF- `T OF-*,' ~9 � 14 ttaEcic x/D 6-7.7 a Ci <br /> !" A?A 3- rlyuR.S GF cG-c>s <br /> 3//1 -7l 7 <br /> /v:00n.- Lt-TO C.AL 04H.4 �2f4 <br /> -, <br /> 31�7�cf� <br /> � �r/rr/�/]vvCT +ris/YSO1V �I <br /> 3/zy/cf/ 3' r'c`7A i�rrscF a z <br /> iJl //o, <br /> / 1 �o•�c,p,�/o.,� I C�N.T GTv�' �t /4�V1C�ccJ' �7ACL55A <br /> 7`7/��'GT r q:�'.`-a:��•�,-► ��INIG,�eE.tivV/4 L `�f'Ya/V(,- ��V�itllE� - <br /> f. r f r Salo — •xl r.snda� F.kdvt � ra�,iE i <br /> � <br /> TOTALS <br /> BAIrMNCE DUE. C, <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/41) <br />