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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # < <br /> COMPUTER/PERMIT # ..5,�-r \J FN <br /> SITUS/FACILITY ADDRESS: <br /> DBA: <br /> BILL TO: c.c) its � ,Jus�r't eS PHONE: "LT 6 -38,0/ <br /> BILLING ADDRESS: 2 -7 1 2- G.✓ S�r a c✓ 2 3 <br /> CITY/STATE: e Srl 0 e zip: <br /> PROGRAM: Z--3�U TYPE OF SERVICE: 7—.L /1-1 �,su �//s ) '-^ <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 /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAIME <br /> of SAKI- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> �- x-02 30 1n f 4 •Cr�i'�✓ �to/I� e.7 IV-4 <br /> I <br /> I <br /> TOTALS <br /> I3AL kNCC DUE: <br /> MILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />