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I <br />ENVIi ., tiIENTAL HEALTH D1 SION <br />ACCOUNTING WORKSHEET <br />UNIT # <br />CONIPUTER/PCR.MIT # <br />ytA <br />SITUS/FA,CpILITY ADDRESS: ko i 1 eY bl l/� <br />DBA: V I l l as o_ W e5� <br />BILL TO: _ (A fLWlt k" S�iIULc2� PHONE: <br />BILLING ADDRESS: <br />CITY/STATE: ZIP: <br />PROGRA.\vt: U5T TYPE OF SERVICE: <br />rr- MINIiMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TI2ME IS COMPUTED TO THE <br />N---.-\.P--ST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br />1l <br />DATE <br />ut <br />SERVICE <br />WEEKDAY <br />SAM- <br />4:30P`I <br />WEEKNIGHT <br />4:30P�I-3AM/ <br />WEEItEvDS <br />HOLIDAYS <br />DESCRIPTION OF WORK <br />RENS N.-kME <br />IlZra'gZ <br />I '2." <br />8l �� <br />I <br />e -+ems Z° <br />2 <br />fsoar <br />Valor <br />, n e -e Tn 5fw-// <br />V16 tqL� a <br />y <br />12:30 — <br />parf f fm /n -fir.:,. <br />P. vi Bess! <br />� 3 9 Z <br />3 : ► � <br />��c. <br />r4 / D 5uM� eSf <br />9 <br />, :oo � <br />� �� <br />� 3 STS . <br />f • 1����� <br />11h, <br />1 <br />rc- <br />� <br />LiOTAH- I I ,� "n / <br />G j <br />6�, /-P <br />ll,�L\NCE DUE: <br />!BILLING D,k,rE: <br />E:i 23 074 (Rev 3/22/91) <br />L/-ZF -%Z <br />