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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> I. <br /> LOCAL OVERSIGHT PROGRAM <br /> i! Responsible Party Information as of 6/15/2005 <br /> LOP SITE FILE INFORMATION <br /> lax <br /> e0 <br /> Case# 1555 Y ; <br /> �eri7�dla1;�vet-� 3. <br /> Site Name A TEICHERT&SON INC* R i1I ° F x <br /> Location: 103 N EST <br /> STOCKTON,CA 952051Eyfd:1 , � €I <br /> Phone 209-946-8580 :., mtt iR int awl RI�L <br /> f'ls; Mi <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 /> si n and return this form. <br /> Make changes/corrections 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 A TEICHERT&SON <br /> u . <br /> Contact GEORGE TAKEMORI <br /> Address P O BOX 15002 <br /> SACRAMENTO,CA 95851 <br /> Phone (916)386-6916 <br /> li <br /> I. <br /> a <br /> r; <br /> if <br /> ii <br /> - <br /> - y . <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator,primary responsible party,or agent of same,acknowledge that all <br /> site,andlor 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 Ordinate Codes and/or Standards and State and/or Federal Laws. <br /> IL <br /> PRINTED NAME: TITLE: <br /> REPRESENTING:' <br /> SIGNATURE: Date ! / <br /> Report#8021 Date 6/15/2005 <br /> li <br />