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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> r <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> it <br /> LOP SITE FILE INFORMATION <br /> r <br /> Case# 0001505 � � x <br /> ' RRA �t9ta�er1R �� a <br /> Site Name 7-ELEVEN 432262 fe� �0�� � <br /> r. "r <br /> Location 2360 W GRANT LINE RD �At�� 1JOfl#� StIZ� h � l <br /> �, x r� 4 <br /> TRACY,CA 95367 ' tity � � <br /> PhonePit~ tjttei�� L � � 62�* <br /> ' M <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]thissite. If this billing information is not accurate, please makenecessary changes in the space provided,da <br /> sign and return this form. <br /> Make changesicorrections in RED ink or pencil. <br /> RESPONSIBLEPARTY INFORMATION RP INFORMATION CHANGE(date) <br /> u <br /> PRI-RP has been named a Primary.RP. <br /> Business Name 7-ELEVEN <br /> i <br /> Contact KEN HILLIARD <br /> Address P O BOX 7111 <br /> i <br /> DALLAS,TX 95221-0711 <br /> Phone <br /> y <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. <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date 1 I <br /> Report#8021 Date 6/15/2005 <br /> a <br /> 1. <br />