Laserfiche WebLink
sow <br /> W. <br /> 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# 0001504 se <br /> Site Name USA GASecllaEttShtoe <br /> / Fi � � Qf? €}4 <br /> R' <br /> Location 2205 COUNTRY CLUB <br /> /� / J <br /> STOCKTON,CA 95204 / <br /> /� <br /> inmi <br /> Phone 114, <br /> i <br /> APN 12121Rt1$ <br /> The following information is currently on file with this Department. The Primary Responsible Party <br /> identified below will be responsible for payment of invoices for direct oversight charges associated wJthissite. If this billing information is not accurate, please make necessary changes in the space provided, <br /> sign and return this form. <br /> Make changes/corrections in RED ink or pencil. <br /> RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(date) <br /> PRI-RP has been named a Primary RP. <br /> Business Name USA PETROLEUM COMPANY <br /> Contact CHARLES MILLER <br /> Address 30101 AGOURA CT.#200 <br /> AGOURA HILLS,CA 91301-4311 <br /> Phone (213)452-6200 <br /> ( a7 <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. <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date <br /> Report#8021 Date 6/15/2005 <br />