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PR440014 0467 CARRUESCO ACTIVE Y N A I D <br />------------------------------------------------------------------------------- <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br />project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br />BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN <br />COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br />APPLICANT'S SIGNATURE: Date 9 <br />----------------------- ------------------------------------------------------- <br />Programs to be TRANSFERED: x $20.00 = Amount Paid Date/ -/9 - <br />Payment <br />/ 9 <br />Payment Type Check # Recvd by <br />-- - - - - - - - - - - - - - - - - - - - - - - - - - - - -- -,t----------------------------------------------- <br />REHS or COUNTER SUPV: Date ( �� / 9 j ACCT out: Date 9 _ UNIT/File: 9 <br />