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ENVIRONMENTAL HEALTH DIVISION <br />ACCOUNTING WORKSHEET <br />UNIT # Z <br />CONIPUTER/PERMIT # <br />SITUS/FACILITY ADDRESS: <br />DBA: 61' / l I &ff� 4/zL� - <br />Dr 1/,0' <br />py-_p- 3' <br />BILL TO: /�/�1,7r/1��I RL/ kV —61�zl <br />BILLING ADDRESS: <br />Z��s � %fie /.Jri�� <br />CITY/STATE: :! 1L) / D s I ZIP: <br />PROGRAi'v1: >� TYPE OF SERVICE: <br />THE MINIMUM TIME FOR EACH INS?ECTION IS ONE (1) HOUR, ANY ADDITIONAL, INSPECTION TEME IS COMPUTED TO THE <br />NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. �j(y�, <br />DATE <br />of <br />SERVICE <br />WEEKDAY <br />SAM- <br />4:30PM <br />WEEKINIGHT <br />4:30PNI-SAM/ <br />WEEKENDS <br />HOLIDAYS <br />DESCRIPTION OF WORK <br />REHS NAIME]� <br />L�lf t v� l�rr. rvr <br />I ', <br />Ins�c�trc Uer{2YM4zc� i�x <br />3D <br />I <br />I <br />I �/� C. P <br />t- <br />111oze"Ilt <br />f�j 771i <br />I <br />TOTALS <br />P„\L,1NCE DUE: - <br />BILLING DA'I'r: <br />23 074 (Rev 3/22/91) <br />R/ <br />NA <br />0' <br />All <br />N`y <br />