Laserfiche WebLink
Defame- 4/1/2013 12:00:02PM SAN JUIN COUNTY ENVIRONMENTAL HEA jW DEPARTMENT Report 95021 <br /> Page2 <br /> Run by Facility Information as of 4/1/2013 <br /> Record Selection Criteria: Facility ID FA0006943 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anb'or project speck,PHS/EHD hourly charges associated with This facility <br /> or activity will be billed to the party identified as the OWNER on this form I also re that all operation will be pa oneed in accordance with all applicable Ordinance Codes eii Standards and State andNor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERE : '$25.00= Amount Paid 1 kp$.Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type ✓ Check Number IPA Rec iv y 3 <br /> REHS: ---7 qqq Date L / / Account out: Date <br /> ZJ <br /> COMMENTS: 1 <br /> lJ/, IL S PAYMENT <br /> RECEIVED <br /> NPR 01 2013 <br /> SAN JOAQUIN COUNTY <br /> ENVIROMENTAL <br /> HEALTH DEPARTMENT <br />