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new ren 4n6n013 2:14:58Pk Stlk1IIJOAQUIN COUNTY ENVIRONMENTAL HE.T'H DEPARTMENT Report#5021 <br /> Paget <br /> Run by <br /> Facility Information as of 4n6n013 <br /> Resume!Selection Criteria: Fadlity 10 FA0002590 <br /> BILLING and COMPLIANCE ACKNOVVLEOGEMENT'. 1,the undersigned ovmea operator or agent of same adnowledge that all site,anchor projed speoRq PHSEHD hourly phages assodated W th the taellty <br /> or atliNty writ be billed to me party identified as the OWNER on this farm I also mor"at all operations wit be performed in accordance with all applicable Ordinance Codes angor Standards and State ander <br /> Federal taws. <br /> APPLICANT'S SIGNATURE: n ` �" ��--9'^ 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 Rece <br /> REHS: Date 47 / Account out Date <br /> COMMENTS: y <br /> �U r,w-,L fJ\ asw fixsVf— uttil <br /> 2��- sU h3 <br />