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Dale nuh 9/9/2013 11:07:25AM SAN JO ,UIN COUNTY ENVIRONMENTAL HEA' _y DEPARTMENT Report 95021 <br /> Run by v Papel <br /> Facility Information as of 9/9/20 <br /> Record Selection Chime'. Facility ID FA0007094 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1.the undersigned owner,operator or agent or dame.acknowledge that all site.andor projed apebec.PHSIEHO hourly charges essouated with this facility <br /> bractivity will W timed to the pant Identified es the OWNER on this roan I also burbly that all operations will be performed in accwdenoe with all applicable Ordinance Codes andor Standards and State andor <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 heck Numbern Recei d — <br /> REHS: Date / / Account out: <br /> COMMENTS: <br />