Laserfiche WebLink
Date run 8/4/2015 9:54:48AM SAN JUIN COUNTY ENVIRONMENTAL HE f DEPARTMENT Report 05021 <br /> Run by Page2 <br /> Facility Information as of 8/4/2 15 <br /> Record Selection Criteria: Facility ID FA0003679 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project speck,PHSEHD hourly charges associated with this facility <br /> or activity will be Vied to the party identified as the OWNER on this form I also caddy that all operations will be performed in accordance with all applicable Ordinance Codes and'or Standards and State ander <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <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 by <br /> EHD Staff: Date_/ /_ Account out: Date / / <br /> COMMENTS: <br /> Invoice#: <br />