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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT #,_ <br /> COMPUTER/PERMIT # UkYVAJ 5G)&-E705 13`18 <br /> SITUS/FACILITY ADDRESS: �-ADf <br /> DBA: rJA OC19z <br /> BILL TO: (A)Ll' AL PHONE: <br /> BILLING ADDRESS: o�2OX d,---'Dccs ( 9iUYQA1 <br /> CITY/STATE: scw /CA7V OA) �Ll-& ZIP: <br /> PROGRAM: TYPE OF SERVICE: �s1a <br /> /cfox, I;L-22�6-"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 NAME <br /> of 8AM- 4:30PM-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> -30 <br /> O� do L �ry � I�iPiny q �kck�i/l <br /> 3O i `� 5Cc a ndQn�l l�iPr n9 �PSf <br /> TOTALS <br /> BALANCE DUE: LJ U E G <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) / <br />