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ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT #,.3 <br /> COMPUTER/PERMIT # 0A-YQA J /3`f8 <br /> SITUS/FACILITY ADDRESS: /BD/ �7TC�=�i�9�1 LR�cIE'. LL,21 <br /> DBA: <br /> BILL TO: t/,(1'�r4 L PHONE: /S�R/ pU <br /> BILLING ADDRESS: C `/ (�A_D LCj <br /> CITY/STATE: -';9-AJ P��VQA) ,��- ZIP: 9�5 <br /> PROGRAM: UCS"% TYPE OF SERVICE: _(1(r7'�'�Sfo//l7�%O�v --r 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 RENS NAME <br /> of SAM- 4:30PM-3AM/ <br /> SERVICE 4:30PM WEEKENDS <br /> 3 Z5"�l a 30 30 <br /> O� Qo �rr.�a.y /JrPriiy `�—ba£c/y%/l <br /> -Z- J <br /> -J� Oo 3� SCGonaQn/ l�irprn� (;PSS' <br /> 30 �7 nam /n Sp PIQ h"�ec.� <br /> TOTALS <br /> BALANCE DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/91) <br />