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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # LIN DE 3n jW I8g3_ _ <br /> SITUS/FACILITY ADDRESS: BeYn <br /> DBA: ­FL c, T n , , I <br /> BILL TO: H . Le,-- % P«xC(o bQ� PHONE: <br /> BILLING ADDRESS: EEL HnIx�P Le LU lt ' ZI I <br /> CITY/STATE: C�<,YYA Vh Oih l ZIP: 0 <br /> PROGRAM: TYPE OF SERVICE: `iiiII Q-Ron �ntn C {1OrT�.�(S(1� <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. <br /> DATEWEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAMEKI <br /> of SA - 4:30PM-3AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> n ti: <br /> l <br /> U <br /> W 4&,tra-w t (r J poy-w <br /> TOTALS <br /> IIALkNCE DUE: <br /> BILLING DATE <br /> EH 23 074 (Rev 3/91) <br />