Laserfiche WebLink
Date run 10/2/2012 8:09:09AN SAN JUIN COUNTY ENVIRONMENTAL HE* DEPARTMENT Repan #5421 <br />Run by Pege2 <br />Facility Information as of 10/2/2012 <br />Record Selection Criteria: Facility ID FA0006943 <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1, the undersigned owner, operator or agent of same, acknowledge that all site, andror project speck, PHS/EHO hourly charges associated with this facility <br />or activitywill be billed to the party identilied as the OWNER on this form Ialso certify that all operations will be performed in accordance with all applicable Ordinance Codes anovor Standards and State and'or <br />Federal Laws, <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS: <br />Date <br />$25.00 = Amount Paid Date _ <br />Amount Paid Date <br />Date <br />Re by <br />Account out: Date _/ 7i <br />