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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as'of 6/15/2005 W <br /> SAN JOAC UIN COU <br /> NTY <br /> lrN11lROi�HE�. AL <br /> LOP SITE FILE INFORMATION HEALTH DEPAR <br /> Case# 0001558 r Local t� ncy Use Only <br /> RemedlaE Oversight . <br /> Site Name UNIVERSAL FOREST PRODUCTS 00001588. <br /> RecpH ID . <br /> Location 26200 NOWELL RD Site Record ID SD0001587 <br /> THORNTON,CA 95686 Facile"Reoord ID ' A000g' 31 f <br /> Phone 209-794-2303 <br /> '� <br /> " APN '0() 0123 <br /> 2o <br /> _ heollowigg_information is-curre�ntlx=onfle:with-this Department. The_Prjmar-v_Resnansiblepar_ty -_ y <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 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 UNIVERSAL FOREST PRODUCTS 1000TH Dw's'c-, C <br /> I Contact M:AqFTfEW"M3SSA'Il— <br /> v <br /> Address 2801 E SELTLINE !� <br /> GRAND RAPIDS,MI 49525 i <br /> Phone <br /> i <br /> VrF <br /> �OV q V <br /> r <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. j <br /> PRINTED NAME:' :Wl —Sex-Per TITLE:M_r l�e�fuit r owr��Y««rP <br /> REPRESENTING: rectuA5 U4:5 Wn <br /> SIGNATURar.�.Pi� d Date1 4 1 c�-oc5" <br /> Report#8021 Date 6/15/2005 J <br />