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i <br /> � L� h ii <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 4, AGE �0 <br /> s I <br /> �s At <br /> LOP SITE FILE INFORMATION '"" <br /> Case# 1555 x p <br /> trld�af f !@I§Qhl <br /> Site Name A TEICHERT&SON INC* <br /> Location 103 N E STd '8 <br /> VR <br /> ire i h <br /> STOCKTON,CA 95205 hitt'Feel <br /> Phone 209-946-8580 <br /> o, <br /> J 4h 1ollowing_information is-curie ntly le_with�hisJ}epartme>n,t��T,heprima lies onsible P.ar. <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. <br /> ,r <br /> Make changeslcorrections 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 A TEICHERT&SON <br /> Contact GEORGE TAKEMORI <br /> Address P O SOX 15002 <br /> SACRAMENTO,CA 95851 <br /> Phone (816)386-6916 , <br /> _ - w <br /> 00 <br /> ;i <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 parry identified as the PRIMARY RESPONSIBLE PARTY on this <br /> form. I also certify that all operations will be performed fin accordance with.all applicable Ordinace Codes andlor Standards and State and/or Federal Laws. <br /> PRINTED NAME: Gef <br /> Georg e + n k o lAo r i TITLE: D f V 19 O fl I��rY�(�1 t STT fDr <br /> REPRESENTING: Te I CI�� r f Son Inc. <br /> SIGNATURE: 6)dl— Date / 24 05 <br /> / <br /> Report#8021 Date 6/1512005 <br /> - i <br />