Laserfiche WebLink
Date run 3/14/2017 4:18:54PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Rrport#5021 <br /> Run by <br /> Facility Information as of 3/14/2017 Paget <br /> Record Selection Criteria: Facility ID FA0003757 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHS'EHD houry charges associated with this facility <br /> or activity will be billed to the party identfied as the OWNER on the form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ander <br /> Federal Laws <br /> APPLICANTS 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 Number Received'bny <br /> EHD Staff: Date / l��j Account out: y/� Date 3 / /� <br /> COMMENTS: <br /> Invoice#: <br />