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L) <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# 1233 P � oc;i1€�1t✓ css O�y <br /> Site Name 7 ELEVEN417334 D/2235 �jppll' OUO� <br /> Location 4501 N PERSHING AVE IjMI �u <br /> STOCKTON,CA 95207 <br /> Phone 209-951-6745 <br /> s� <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',lmake necessary changes in the space provided,date, <br /> sign and return this form. <br /> Make changes/corrections in RED ink or pencil. <br /> RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(date). <br /> N <br /> PRI-RP has been named a Primary.RP. <br /> Business Name 7-ELEVEN <br /> Contact KEN HILLIARD <br /> Address P O BOX 711 <br /> DALLAS,TX 95221-0711- <br /> Phone <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 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 /> T <br /> Report#8021 Date 6/15/2005 <br /> i <br /> a <br /> ' i <br />