Laserfiche WebLink
Date ruli 11/30/2015 9:14:04A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT : Report#5021 <br />Run by <br />Facility Information as of 11/30/2015 j Paget <br />Record Selection Criteria: Facility ID FA0009092 I <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andlor project specific, 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 certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Type Check Number Received by <br />EHD Staff: 2 V c-' N r— t_ v k Date 1.30 / 1 5 Account out: Date / / S <br />COMMENTS: <br />Invoice #: <br />I <br />