Laserfiche WebLink
Date run 11/10/2015 11:01:051 SAN JOAQUIN COUNTY ENNiAIRdiNi"VIENTAL HEALTH DEPARTMENT Report#W21 <br /> Run by ` <br /> Facility Information as of 11/10/2015 Paget <br /> Record Selection Criteria: Facility fD PA0002715 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER cn this form_ I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and'or Standards and State and<cr <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date / ! <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date I I <br /> Water System to be TRANSFERED: Amount Paid Date ! ! <br /> Payment Type Check Number Received by <br /> EHD Staff: Date I I Account out: Date ! / <br /> COMMENTS: <br /> Invoice#: <br /> NOV 10 201 <br /> ENVIRONMENTAL <br />