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,��- I'y- ; I I�U, I��4: ,' r Pit U 5:�. N t I F U L t U�J F l+.X. lJ C. j l� 1 U';1',.,, <br /> Jul-19-07 03:50P P-02 <br /> SAN.10AQUIN COUNTY ENVIRONMENTAL HEALTH DEPAK"1 MENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 7/19/2007 <br /> LOP SITE FILE INFORMATION <br /> Case tt 0001504 <br /> Site Nam® <br /> Location 2705 COUNTRY CLUB <br /> STOCKTON,CA 95204 <br /> Phone <br /> The following information is currently an file with this Department, The Prilinary Respnnsihlc Party <br /> identified below will be responsible for payment of invoices for direct oversight charger. ai4ocinted with this <br /> site. If this billing information Is not accurate, pleztse make neeess3ry changes in the space providcd, ;'ate, <br /> s� rn and rgtuthis form. <br /> Make shangeeteorraetion%In RED Ink or poneli. <br /> RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(date)_TI tQ�o <br /> PRI-RP hes been named a POMarz12� <br /> Business Narne USA COMPANYA <br /> Contact CHARLES MILLER <br /> Address 91115 RANCHO CONEJO BLVT) <br /> NEWfiIJRV PARK,CA 91320-1716 <br /> Phone (21 24"F— r ]�21 ' 9 Z©C ) 2 VI <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT_ 1.the undersigned owner,operator,primary responsible party,or agent of same,acknowledge that all <br /> site,and/or project specific.EMD hourly charges associated with this site wig be billed to the party identified as the PRIMARY RESPONSI1131-E PARTY on this <br /> form. I also cettlry thxl ail operations will be performsmeld in accorclance with all applicable OMinaca Codes and/or Standards slid State andlor Federal Laws. <br /> PRINTED NAME: - 1 it t } TITLE: 014ra-3 BJ` <br /> REPRESENTING: S A'0 e GASWA's �^ <br /> SIGNATURE: Date /-19 <br /> Report 0 6021 -� Oats 7ity/2t1n1 <br />