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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # <br /> COMPUTER/PERMIT # I7 D <br /> SITUS/FACILITY ADDRESS: 41315 l y) to-o. v <br /> DBA: <br /> BILL TO: �• PHONE: <br /> BILLING ADDRESS: 13 3 7 141rw►e f u2< < �,uI <br /> CITY/STATE: J alj '&0-49-alf ZIP: <br /> PROGRAM: G/C'S f TYPE OF SERVICE: !/[ " i dY`' <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME` COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of RANI- 4:30PNI-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> t- <br /> z- i JK, &;7 A.6a <br /> ,I <br /> i <br /> i <br /> r <br /> TOTALS <br /> I ALkNCC DUE: <br /> 13ILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />