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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTERIPERMIT # <br /> SITUS/FACILITY ADDRESS: Z6 <br /> DSA: <br /> Oke,HdRd Sara v }�Dl , G /57e�6tia�iv,.� 64-v % <br /> BILL TO: L. 5 PHONE: 6- <br /> BILLING ADDRESS: GI O G 7 . 6 K 0 K <br /> CITY/STATE: S U i✓PJ\/l�/'yV ZIP: Y© <br /> PROGRAM: TYPE OF SERVICE: <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. ? /A5 ?A.;4o O/\-/ / 7� k ��,#4 <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS. DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> s <br /> TOTALS <br /> BAIANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />