Laserfiche WebLink
.k <br /> Date run 12/30/2015 1:57:17F SAN JOgIN COUNTY ENVIRONMENTAL HEAD DEPARTMENT Report#5021 <br /> Run by Page2 <br /> Facility Information as of 12/30/20 5 <br /> Record Selection Criteria: Facility ID FA0010390 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anclor project specific,PHSEHD hourly charges associated with this facilry <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 and'or Standards and State andbr <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date / I <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 /> EHDStaff: tU'Y.�N�D Date(2/ 5�10 / 2015 Account out: Date 12— / 550 / �S <br /> COMMENTS: <br /> Invoice#: <br /> i2�3o��5 pity 1-ec "-ham 6y,- 110,C 1s. Tease <br /> l (�► r,cfk,Ve <br />