Laserfiche WebLink
ENVIRONMENTAL HEALTH DIVISION <br /> �� ACCOUNTING WORKSHEET <br /> UNIT # , � <br /> COMPUTER/PERMIT # C e V 5 cc1Qf S# <br /> SITUS/FACILITY ADDRESS: (o4o 3-3 ?0,6(tc N" V2, <br /> DBA: 151LL- i'AfKS Je:?ZVICC T TIONS <br /> BILL TO: Rop-&-:x-r N - t1-�©c. PHONE�q/w <br /> BILLING ADDRESS: _��J�J T f-bwe AVE- 45U t`t-c- 2 I <br /> CITY/STATE: �J '- i YV��� +�' ZIP: "� '5Ez <br /> PROGRAM: t� �T TYPE OF SL-RVICE: e,-T7()SJ /LCEncij <U <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL INSPECTION TIME IS COMPUTED TO THE <br /> NEARES HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> Qlcp // hrs <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAME <br /> of SAM- 4:30PIVI-SAM/ <br /> SERVICE 4:30PM WEEKENDS <br /> l� �c�llv�zti n i a-bu- <br /> 2-rt Q 1 0DO eVIeW Y29ub ' <br /> t-Al+ <br /> 2N :aa phone caeC.# r�u:.e�c> ,,�f <br /> //-DU AYrl c rc5rl6mr s �m G�/6 <br /> l 0 C) rAv i-cu))S v bm i <br /> Ici 3 v a ( Sup e .f&,- nsQ c s,rcJ� v i �2 <br /> TOTALS <br /> IIALINCC DUE: <br /> BILLING DATE: <br /> EH 23 074 (Rev 3/22/91) <br />