Laserfiche WebLink
Date run 4/11/2013 2:00:03PN SAN JOA IN COUNTY ENVIRONMENTAL HEAL._ DEPARTMENT Report#5021 <br />Run by Page2 <br />Facility Information as of 4/11/2013 <br />Record Selection Criteria: Facility ID FA0009525 <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD 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 and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type ht <br />RENS: cam\ irfs/f 1 <br />' $25.00 = <br />mber <br />Date <br />Date <br />Amount Paid Date <br />_ Amount Paid Date <br />Received b 1 <br />_ Account out: Date /�/ -3 <br />