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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> CONIPUTER/PE-RMIT# <br /> SITUS/FACILITY ADDRESS: /7/00 S. WA&,4A A ,a6 G4Ti�4 G� <br /> DBA: 067,41 <br /> BILL TO: s- fT T i /. �o, <br /> 17HONE:BILLINGADDRESS: Q /30 X1599 <br /> CITY/STATE: 714l—O11CfA�--, 61(1 - ZIP: S/'/S-o 9aal <br /> PROGRAM: TYPE OF SERVICE: <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPU'T'ED TO THE <br /> NEAREST HALF (1/2) HOUR INCLUDING TRAVEL TIME, <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NA1AIE <br /> of 3AlvI- 4:30PM-SAM/ <br /> SERVICE 430PM WEEKENDS <br /> i <br /> TOTALS <br /> BALUNCE DUG: <br /> 13ILLING DATr: <br /> EH 23 074 (Rev 3/22/91) <br /> 1 i <br />