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SAN JOAQUIN-i -'UNTY ENVIRONMENTAL HEALTH DF�RTMENT <br /> I LOCAL OVERSIGHT PROGRAM <br /> I Responsible Party Information as of 4/24/2008 <br /> I <br /> LOP SITE FILE INFORMATION <br /> ocal Anency Ilse Only = s, <br /> Case# 508378 e <br /> M emedlal O�erslghtR00000704 1 <br /> Site Name PACIFIC AUTO CENTER <br /> Location 25355 N HWY 99 SttB-Re o d IDa S>3g000704v, �e ' <br /> ACAMPO, CA 95220 , Facildy Record ID FE10008045. 4 k. <br /> Phone 209-339-4046 <br /> 4 � <br /> AP.N ;005 3-U7 1 <br /> , <br /> I <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 /> Make changes/corrections in RED ink or pencil. <br /> it RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(date) <br /> JPRI-RP has been named a Primary RP. <br /> Business Name EXXON MOBIL <br /> I Contact JENNIFER SEDLACHEK <br /> j Address 4096 PIEDMONT AVE#194 <br /> OAKLAND,CA 94611 <br /> Phone <br /> I <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,EHD hourly charges associated with this site will be billed to the party identified as the PRIMARY RESPONSIBLE PARTY onthis <br /> form. I also certify that all operations will be performed in accordance with allapplicableOrdinate Codes and/or Standards and State and/or Federal taws. <br /> 4 <br /> {f PRINTED NAME: TITLE: <br /> { REPRESENTING: <br /> y SIGNATURE: Date <br /> I <br /> Report#8021 Date 4/24/2008 <br />