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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> LOP SITE FILE INFORMATION 5 <br /> f <br /> � s'3 <br /> Case# 507797 <br /> Site Name WILBUR ELLIS COI H&H ENGINRNG ID ItQ€?0 23 <br /> Location 212 INDUSTRIAL DR <br /> STOCKTON,CA 95206cilii Riircllt 1 AtI�7�7 � <br /> Phone 209-983-0708 Qtit 5lttrs;E t1t I s , TCW1rI✓RIN CC)I+T T12. <br /> y <br /> The following information is currently on file with this Department. The Primary Responsible Party <br />°I identified below will be responsible for payment of invoices for direct oversight charges associated wJ�dLate, <br /> site. If this billing information is not accurate, please make necessary chanizes in the space provided <br /> sign and return this form. <br /> Make changeslcorrections 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 WILBUR ELLIS CO <br /> Contact JAN THOMPSON <br />{ <br /> Address P O BOX 1286 <br /> FRESNO,CA 93715 <br /> Phone (559)226-1934 <br /> I 3� <br /> fl� oD <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 andlor Standards and State and/or Federal Laws. <br /> i PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date / 1 <br /> i <br /> Report#$021 Date 6/15/2005 <br /> I <br />