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Date Run 8/11/2025 4:35:32 PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 5021 <br /> Run By CHILD Page 2 <br /> Facility Information as of 8/11/2025 <br /> Record Selection Criteria: Facility ID FA0026302 <br /> 2220 - SM HW GEN <5 TONS/YR PROS46536 HSAEED - HAZA SAEED Active, billable y N A I D <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 or activity <br /> 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 Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFEFRED: ' $25.00 = Amount Paid Date <br /> Water System to be TRANSFEFRED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> EHD Staff: Date / / Account out: Date / L l / <br /> COMMENTS: INVOICE #: <br />