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2013-02-22 14:46 Manteca 2099821205 >> 2044683433 P 3/7 <br />AN JOAQUIN COUNTY ENVIRONWNTAL HEALTH DEPARTMENT <br />SERVICE ST <br />CONTRACTOR / <br />* _ 1 <br />Cad Wayne Henderson 303520 cmm if BILuNc, <br />Service . <br />Mt° SWWon STATE CA zW 95213 <br />i G MEDCR1ViP:N7'. X, ft undersigned property of bahM emer, operator or authorlind agent of same, <br />oftowhfto that Eli site m&or project specific ENvM0N=4TAL HEALTH DPPAR7wm hourly charges moclatedwith this project <br />or activity wilt be billmi to Me or My basinew as identified on the fbtm. <br />Y also earthy that I have prepared this application and that the vm& to be performed will be done in accordance with all SW JOAQUIN <br />COUNTY Ordimm Codas, Standards, STATE and FWERAL ISM <br />AIMUCANT'S SIGNATURE: DATz:149/13 <br />PRonmil;uwawowwaD oP croatMxm= cz OTHnAmmom mAcm W President <br />YAPP11C&' is net the 404W P,e= proof ofma n to sign is ftWJW rifle <br />AUT Q ON IQ P-ELL441 T1QF4RMA'[11O : When applicable, L the owner or operator of the property located at the <br />above she addrm, hereby atahorixe the release of any and all resuft ScoweWcal data and/or environ trAn 'Re assessment <br />information to the SAN JOAQLnN COUNTY ENviRow4wAL l• O ALTtt DEPAR,Ttvf WT a$ goon as it is available and at the game title it 1S <br />providedtorneormyrappmentative. <br />rM oF SfiRvicE R=UM: TankRetroft <br />PA 1A <br />7ankgard ATG: Replaced sensor wires to Zone I and repaired sensor connection at zone 2. Ch . ' —' <br />adi <br />4 <br />f <br />Pee 0 <br />V -. <br />84 <br />-014 <br />•.,. r ., <br />P4 <br />port <br />I,M:1 <br />Oats: <br />8e TD; EMKOYNI #: ".G 6 9�0 <br />DATS. l i <br />774�= <br />R IF-, <br />Faa Amount:.. Amount Paid <br />CONTRACTOR / <br />* _ 1 <br />Cad Wayne Henderson 303520 cmm if BILuNc, <br />Service . <br />Mt° SWWon STATE CA zW 95213 <br />i G MEDCR1ViP:N7'. X, ft undersigned property of bahM emer, operator or authorlind agent of same, <br />oftowhfto that Eli site m&or project specific ENvM0N=4TAL HEALTH DPPAR7wm hourly charges moclatedwith this project <br />or activity wilt be billmi to Me or My basinew as identified on the fbtm. <br />Y also earthy that I have prepared this application and that the vm& to be performed will be done in accordance with all SW JOAQUIN <br />COUNTY Ordimm Codas, Standards, STATE and FWERAL ISM <br />AIMUCANT'S SIGNATURE: DATz:149/13 <br />PRonmil;uwawowwaD oP croatMxm= cz OTHnAmmom mAcm W President <br />YAPP11C&' is net the 404W P,e= proof ofma n to sign is ftWJW rifle <br />AUT Q ON IQ P-ELL441 T1QF4RMA'[11O : When applicable, L the owner or operator of the property located at the <br />above she addrm, hereby atahorixe the release of any and all resuft ScoweWcal data and/or environ trAn 'Re assessment <br />information to the SAN JOAQLnN COUNTY ENviRow4wAL l• O ALTtt DEPAR,Ttvf WT a$ goon as it is available and at the game title it 1S <br />providedtorneormyrappmentative. <br />rM oF SfiRvicE R=UM: TankRetroft <br />PA 1A <br />7ankgard ATG: Replaced sensor wires to Zone I and repaired sensor connection at zone 2. Ch . ' —' <br />adi <br />operation multiple times. <br />Pee 0 <br />84 <br />-014 <br />port <br />Accainzo Br: caaEMLOYIE #r 'J p <br />Oats: <br />8e TD; EMKOYNI #: ".G 6 9�0 <br />DATS. l i <br />Ditto Service Completed (it atropQy cgrnptatAdj: t lZ9/13SERvlc8 COOL, j E?� Q <br />R IF-, <br />Faa Amount:.. Amount Paid <br />Payment Date <br />Payn+ont Typo Invoke # <br />Check # 124Z-- <br />Received BY; <br />9HO 4M2-026 SR FORM (G*ett ROd) <br />F"SgD 11117120ttS <br />