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Dale run 8/24/2015 4:45:19Pn SAN JOIN COUNTY ENVIRONMENTAL HEAV DEPARTMENT Repor1#5921 <br /> Run by Page2 <br /> Facility Information as of 8/24/20 <br /> Record Selection Criteria: Facility ID FA0004740 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSIEHD hourly charges associated with this facility <br /> or 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 andor Standards and State andor <br /> Federal Laws. <br /> APPLICANTS 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_I / Account out: Date <br /> COMMENTS: Invoice il: <br />