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Rule run 5/18/2015 4:18:15PA SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1 <br /> Run <br /> by Report lt5021 h. <br /> Record SeleWon Crttena: FFacility Information as of 5/18/2015 Pagel <br /> etlGry ID FA0010686 hy <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the untlenpnad comer,operator ar agent of same,aclar"adge that all aib,andorpmiep apeclfic,pHffiEHD hourlythe <br /> wactivity will de billed to the paM1y ldeMdled es the OWNER on Nis Mm I ale-certify that all operetiena will be poaair atl in eccortlance with ell applicabb Ordinance Cabo anNors associated <br /> ssocia anwan INat.and'or F <br /> Federel Laws <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: $25.00= Amount PaidDate_/_/_ <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> COMMENTS: <br /> Staff:MENTS: Date_I_/ Account out: Data <br /> Invoice#: <br />