Laserfiche WebLink
Dale run 2/9/2011 2:32:08PM SAN JO A'ilUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by 5290 Illiov <br /> Paget <br /> Facility Information as of 2/9/204.1 <br /> Record Selection Criteria: Facility ID FA0009750 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS1r HD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify(hat all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> Stale andror Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I / <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 ,rr Receiv#Uy <br /> REHS: Date–,v? /� Account out: Date 2— <br /> COMMENTS: <br /> lleh-env\en visionlreports\5021.rpt <br />