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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> LOP SITE FILE INFORMATION <br /> Case# 2371 � � c <br /> EARTHGRAIN > tvtTt > <br /> Site Name <br /> m. �owtd 1[�: <br /> Location <br /> 1717 5 CENTER ST tf t2 i a.. ..tt : 51 .110 <br /> STOCKTON,CA 95206 Ili t400Xd l0 FA <br /> Phone 209-465-0905 Gtft 13ia �ss ;� PFtTS' v <br /> e <br /> RA <br /> The foilowin >cnformation.-is_curl ently_on-rilewith thisAepartment.;�T -Primar-v Responsible.-Party <br /> identified below will be responsible for payment of invoices for direct oversight charges associated with this <br /> site. If this billing information is not accurate, please make necessary changes in the space provided,date, <br /> sign and return this form. 4 <br /> Make changes/corrections in RED ink or pencil. <br /> RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(date) 001 oS ' <br /> PRI-RP has been named a Primary RP. <br /> Business Name S NG SA.eA L6E 43A,r�,¢u <br /> Contact LAURA ANDREW <br /> Address 8400 MARYLAND AVE <br /> ST LOUIS,MO 63105-3668 } <br /> Phone (314)259-70% 31 2 SQ—70-7 i <br /> -7 b'? 1 a <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator,primary responsible party,or agent of same,acknowledge that all <br /> site,and/or project specific,EHD hourly charges associated with this site will be billed to the party identified as the PRIMARY RESPONSIBLE PARTY on this <br /> form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal Laws. t <br /> PRINTED NAME: 14ser4- a/rz ..J TITLE: <br /> M <br /> REPRESENTING: <br /> SIGNATLIRE:C.�G� „__ Date <br /> f <br /> Report#8021 Date 6/15/2005 <br /> k <br />