Laserfiche WebLink
Date run 3/7/2022 3:31:59PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Paget <br />Facility Information as of 3/7/2022 <br />Record Selection Criteria: Facility ID FA0004443 <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT I the undersigned owner, operator or agent of same, acknowledge that all site, ancyor project specific, PHS'EHD hourly charges associated with this facility <br />OF activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes anr➢or Standards and State and'or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: Date 3 / 7 / ?,— <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 Received b <br />EHD Staff: c'se� Qtetic�L Date _/ %'i / Account out: Date! /,Z2— <br />COMMENTS; <br />Inunira $- <br />QPAA� s Aa ° [,`,, l c AAa55 cv4 eii e g eitic-y no h" �`cufi`otn <br />C&hAP . i 11.�.�r �,�G►l ����y <br />