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ENVIRONMENTAL HEALTH DIVISION <br />ACCOUNTING WORKSHEET <br />UNIT# M <br />COMPUTER/PERMIT # P-% NO C, I U <br />SITUS/FACILITY ADDRESS: jQcq t leg �c <br />DBA: P-,, 6 Q (,) q .3 <br />BILL TO: lz IN " e- k% cl/ 4- De` ( 0 1 ,1 c— PHONE: <br />BILLING ADDRESS: t" o � oy- f <br />CITY/STATE: Q coos QlAJ cU ZIP: 9 5 776 - Z051 <br />PROGRAM: a3 9-0 TYPE OF SERVICE: i� A vt5 ip c cAj o -i <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 <br />of <br />SERVICE <br />WEEKDAY <br />SA?Vf- <br />4:30PM <br />WEEKNIGHT <br />4:30PM-SAM/ <br />WEEKENDS <br />HOLIDAYS <br />DESCRIPTION OF WORK <br />REHS NAME <br />geen cAA <br />TOTALS <br />BALkNCE DUE: <br />BILLING DATE: <br />EH 23 074 (Rev 3/22/91) <br />0 46 <br />Im <br />