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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTERTERMIT # _� I-7 c� <br /> SMUS/FACILITY ADDRESS: , >!�/ I/� / -1 !��/ 'G✓S �ZD /S�7i3/ <br /> DBA: �7��i ✓f� / d�Gl �i`� [h�// <br /> BILL TO: Si Z--\1A 7/-e-,m �Fn/ f: T c <br /> BILLING ADDRESS: I I I W , L L,.g j SIJ G <br /> CfIY/STATE 5-T(2i �i� ZIP: <br /> PROGRAM: U� '�T TYPE OF SERVICE: �L/� n� P&V/P.t,-) D< lrn /C <br /> THE MINIMUM TA4E FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TUAE IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. 3 � C <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 430PM-8AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> ° '/-,4tev �e✓/e� 1 �i tf2 <br /> vw( fh/ <br /> TOTALS <br /> IIA"NCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />