Laserfiche WebLink
111, <br />•Date run 8/26/2015 2:02:57PA SAN JOIN COUNTY ENVIRONMENTAL HEA0DEPARTMENT Report #5021 <br />Run by Paget <br />Facility Information as of 8/26/2015 <br />Record Selection Criteria: Facility ID FA0002715 <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andlor 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. Ialso certify that all operations will be performed in accordance with all applicable Ordinance Codes ancyor Standards and State anNor <br />Federal Laws. <br />APPLICANTS SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Type I eck umber Received y _ <br />EHD Staff: Date _�/Ca / / t Account out: L6 Date <br />COMMENTS: <br />Invoice #: <br />