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t <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# 1555 asei I <br /> �3 <br /> . <br /> eti Ii�l <br /> Site Name A TEICHERT&SON INCA00M1 *{ <br /> # l;a Ip <br /> Location 103 N E ST <br /> STOCKTON,CA 95205 e;l I r tdl 1 4 <br /> r <br /> Phone 209-946-8580 { <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 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 /> , 1 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 A TEICHERT&SON <br /> Contact GEORGE TAKEMORI <br /> Address P O BOX 15002 <br /> SACRAMENTO,CA 95851 <br /> Phone (916)386-6916 k <br /> 4 <br /> 1 <br /> i <br /> 1 <br /> 1 <br /> . 1 <br /> ° <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 /> i <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date <br /> i } <br /> Report#8021 Date 6/15!2005 <br />