COMPLIANCE INFO_2013 - 2018 - Laserfiche WebLink

Home Browse Search

y r i 1 • / k 3i� +,k.d F�k -f r r.1 e k 1 k 4 ✓r r 1 i A r ,.9� !{e` Yie t Y ; f k }ii •j + ,.�.Y`�i 7.'0."tf 'r ,y y F•1 '1y 'f� yrrk , , f k s . SLING-AOKNQEDOEIVIENT: I, the -undersigned property or business owner, operator or authorized agent of same, - acknowledge that 0 sett; and%i#oject specific ENVIRONMENTAL HEALTH DEPARTMENThourlycharges associated with this project of activity will be billed tome or-mybusiness.as.adentified_onthis.form I.ahso certify f11at.I have prepared` , scation and that the work to be performed will be done in accordance with all SAN JOAQUII I COUN.TY Ordinance Codes, Standards,. -STATE and, FEAERALlaws. APPLICANT'S SIGNATURE:�f Yf 141-: � DAVE: yY PROPERTY /BUSINESS OWNER 'OPERATOR/MANAGER `0 OTHERAUTHOR=DAGENT r r; fAPPLICANT.is not.the.BHLDVGPAR TY proofofauthorizadon tosign is required 'r Title AUII£ORLZATION TO RELEASE TNFf3R1�IATIQNN Wfien-aip6_blt, the;oivner or operator offhe property located at the — -- w ao et site address hereby::authorize the releasti o -and.W zesults; . geotechnical data .an o�rtmentaY ite assessment .. --- V. 1 armabfl3i the SAN JOAQ COIJNTY ENVIRONMENTALHEA•LTH DEPARTwNT-as soon as itis available and at the same.time it -is protide t o qi, my representative. --- liIN �CpMs —WAIZU .1,�N U 45 c sqN 8 2013 - �_ _ '�EAITj.�t OEn'►EIyT� PART C MFj y�. "ACCEPTED BY: #� EMPLOYEE.#: WE Si1GNED TO: @�y JGIYIPLOYEE-#.' DATE' X11 Date Service Completed (if already completed): SERVICEGODE: ( PIE:. Fce Amount: % .. Amount Pai : 76 D .... Rayme Date T_. !3 , k M ' f +•t +a,."•• - ••-y � • h • " f e 1 ' kit f .+'`' sc. , • e'+. i Y • i � y k a •k k i , SAN JOAQUIN COUNTY ENVIRONMENTAL. HEALTII DEPARTMENT SERVICE REQUEST k Type of Business or Property FACILITY ID # SERVICE REQUEST # 0 QVVNER I OPERATOR CHECK'If'BILLINGADRESSCD a F71CILfrY NAME' „«k _ 'I1,N " SITE ADDRESS '/ _ 1 . I. . Street Number . Direction treet Name Cit Zi Cod S HQ�E or MAILING ADDRESS (if Different from Site Address) p, Street Number Street Name £fiY STATE ZIP .. PHONE #1 Exr•APN # LAND USE APPLICATION #• 4.., P]ON E#2, BOS DISTRICT LOCATION CODE .CONTRACTOR /SERVICE 1 EQUESTOR REQUESTOR CHECK IfBILLING �( ;BUSINESS NAME TT. r PHONE JDDRE Exr INOME or MAILING ADDRESS FAX# 1 ...._. _ 2-535 l -, (Zc�i, 1-C� CI rY STATE 4 ZIP C� v SLING-AOKNQEDOEIVIENT: I, the -undersigned property or business owner, operator or authorized agent of same, - acknowledge that 0 sett; and%i#oject specific ENVIRONMENTAL HEALTH DEPARTMENThourlycharges associated with this project of activity will be billed tome or-mybusiness.as.adentified_onthis.form I.ahso certify f11at.I have prepared` , scation and that the work to be performed will be done in accordance with all SAN JOAQUII I COUN.TY Ordinance Codes, Standards,. -STATE and, FEAERALlaws. APPLICANT'S SIGNATURE:�f Yf 141-: � DAVE: yY PROPERTY /BUSINESS OWNER 'OPERATOR/MANAGER `0 OTHERAUTHOR=DAGENT r r; fAPPLICANT.is not.the.BHLDVGPAR TY proofofauthorizadon tosign is required 'r Title AUII£ORLZATION TO RELEASE TNFf3R1�IATIQNN Wfien-aip6_blt, the;oivner or operator offhe property located at the — -- w ao et site address hereby::authorize the releasti o -and.W zesults; . geotechnical data .an o�rtmentaY ite assessment .. --- V. 1 armabfl3i the SAN JOAQ COIJNTY ENVIRONMENTALHEA•LTH DEPARTwNT-as soon as itis available and at the same.time it -is protide t o qi, my representative. --- liIN �CpMs —WAIZU .1,�N U 45 c sqN 8 2013 - �_ _ '�EAITj.�t OEn'►EIyT� PART C MFj y�. "ACCEPTED BY: #� EMPLOYEE.#: WE Si1GNED TO: @�y JGIYIPLOYEE-#.' DATE' X11 Date Service Completed (if already completed): SERVICEGODE: ( PIE:. Fce Amount: % .. Amount Pai : 76 D .... Rayme Date T_. !3 , k M ' f +•t +a,."•• - ••-y � • h • " f e 1 ' kit f .+'`' sc. , • e'+. i Y • i � y k a •k k i ,