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Date nun 5/18/2015 4:19:44Ph SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Rapon#5021 <br /> Run by <br /> Facility Information as of 5/18/2015 PSBe2 <br /> RecoN SBIBLtga CMan.: Featly ID FA0009092 <br /> BILLING ar COMPLNNCEACKNOWLEDGEMENT: I,tha un egneCtrwner,operatww agent assns,ackn aalga shat all slue,anaorpmjest speaic,PHSEHO hourlycharpes associateGwiththisrzcility <br /> orsitbviry will ba Waal to the pally klanlified as the OWNER oMN,iam. I-IW mr*that an oaaniRionsWill W performed In axwdance with all applicable O lshare aColes ardor aan s anti Stale anal,, <br /> FWeral 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 b <br /> EHD Staff: Date_/ /_ Account out Date_/ Z�l� <br /> COMMENTS: <br /> Invoice. <br />