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II Report#8D21 <br /> t Daterun 6/1012005 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Pagel <br /> Run by LCotUHa <br /> LOP Responsible Party Information as of 6110/2005 <br /> Make changesicorrections in RED ink or pencil <br /> ' RP INFORMATION CHANGE(date) <br /> • I <br /> LOP SITE FILE INFORMATION ,. <br /> r <br /> Remedial Oversight Record ID R00000013 ;� Case# ]073 <br /> Site Record ID SD0000013 Facility iRecord ID FA0002064 <br /> Site Name 7 ELEVEN STORE#14117 D/2237 Current Site Business 7 ELEVEN STORE#14117 D/2237* <br /> Location 2725 COUNTRY CLUB BLVD <br /> STOCKTON,CA 95204 APN 121-210-06 <br /> Phone 209-463-1259 <br /> The following information is currently on file with this Department:~ The Primary Responsible Party identified <br /> below will be responsible for payment of invoices for direct oversight charges associatedIMS site. If this <br /> billing information is not accurate, please make necessary chanties in the space provided,date,sign and return <br /> this form. I <br /> h <br /> RESPONSIBLE PARTY INFORMATION <br /> PRI-RP has been named a Primary RP. i <br /> i <br /> Business Name +t I <br /> 7-ELEVEN <br /> Contact KEN HILLIARD M <br /> Address P O BOX 711 I <br /> DALLAS,TX 95221-0711 <br /> Phone M <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,theigned owner,operator or agent of same,acknowledge that all site,and/or project specific PH EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as th WNE bn this form. I also certify that all operations will be performed in accordance with all applica a Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. E <br /> I <br /> APPLICANT'S SIGNATURE:' Date 1 1 <br /> i <br /> I <br /> I <br /> I <br /> I I <br /> I j <br /> I <br /> H:IEnvision Reports18021.rpt <br />