Laserfiche WebLink
Date run 11/30/2015 9:14:04A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Page2 <br /> Facility Information as of 11/30/2015 <br /> Record Selection Criteria: Facility ID FA0009092 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly ch�rges 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 an 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 r <br /> EHD Staff: y c�t'i L_ u I✓ Date I L/ -30 / j 5 Account out: Date /Zf <br /> COMMENTS: Invoice#: <br /> I <br /> I <br /> i <br /> I <br /> I <br /> I <br /> i <br /> l <br /> I <br /> I <br /> I <br /> 1 <br /> I <br /> I <br /> i <br /> l <br /> i <br /> I <br /> I <br />