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i <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of /15/2905 .4 <br /> I I <br /> LOP SITE FILE INFORMATION <br /> Case# <br /> 1299 <br /> R , rrdit� erst9l�t IfO (1f��5� ;; j' � k <br /> Site Name THRIFTY OIL#•171 " rd,l <br /> Location 1250N WILSON WAY Cd) " <br /> STOCKTON,CA 95205 axil 1ilf)01 �. <br /> Phone 800-800-4862 <br /> The following information is currently on file with this Department.° The Prima Res onsible Par I <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 chances in the space provided,date, <br /> si n and return this form. ( I� <br /> r <br /> Make changesiciorrections in RED ink or pencil. <br /> RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(date) <br /> E i , <br /> PRI-RP has been named a Primary RP. <br /> Business Name THRIFTY OIL CO ' <br /> Contact MICHAEL BOWERY I �� <br /> Address 13116 IMPERIAL HWY I I� <br /> SANTA FE SPRINGS,CA 90670 <br /> Phone (800)800-4862 <br /> I ;s <br /> II <br /> I�I <br /> E I <br /> I <br /> I <br /> 1 <br /> A oaf <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator,primary respon ible 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 partyidentified as the PRIMARY RESPONSIBLE PARTY on this <br /> form. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and State and/or Federal Laws. <br /> PRINTED NAME: TITLE: ii i <br /> REPRESENTING: <br /> I ' <br /> SIGNATURE: 1 it Date ! 1 <br /> ii <br /> Report#8021 � Date 611512005 <br /> ,s <br /> i <br /> I <br />