Laserfiche WebLink
Date Run 8121120254',19:49 PM SAV JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Rap d$021 <br /> R.r Br STHAMMAVONGSA Page 2 <br /> Facility Information as of 8121!2025 <br /> Record Seiection Criteria: Facility ip FA0002643 <br /> 4242 WASTEWATER Tx PIANT PRO42DO87 STHAMMAVONGSA SASTINA Aclive,billable Y N I A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT !,the undersigned ewnar operator or agent of same,a Lrawledgv that ati srta.end{or P-1-t specnfrc.PHSIEHO hewly charges•ssocrated with the facility pr act—ly <br /> wrll be bttled to the party Identified as the OWNJA on this lofm.:also certify that all operations will be performed In accordance with all applicable Ordinance Codes and/or Standards and State and/or Federal Laws <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFEPRED- '$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFEFRED- Amount Paid Date 1 ! <br /> Payment Type � Check Number Q Received by <br /> EHD Staff: .! r(,,tAm a U Y P1 Date i/ 1 l-W— Account outI'letDate 2v <br /> COMMENTS: <br /> INVOICE#� <br /> � [vJ <br />