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Gate turf" 1/3/2012 11:49:14AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Page2 <br /> Facility Information as of 1/3/2012 <br /> Record Selection crilerle: Facility ID FA0006832 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of some,eanowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identifild as the OWNER on this Poem. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State antl/or Federal Laws. <br /> APPLICANT'S SIGNATURE: / i Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Paym y Check Number Received by <br /> REH Date Account out: Z Date Z/ <br /> Account /Z <br /> COMMENTS: <br /> \\eh-envNenvision\reportSk502l.rpt <br />