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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 <br /> C,, VUSt3 SflY a. f <br /> Case# 1195 r <br /> Site NameTOCKTON SCAVENGER ASSOC <br /> S <br /> Location 1240 NAVY DR g5t�e ate oS U 27 <br /> STOCKTON,CA 95206 fir.,;cllltj�Re� D H l k 3 . <br /> Phone 209-946-5721 �� <br /> a <br /> �# g 2 R <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 chanl4es in the space provided, date, <br /> sign and return this form. <br /> Make changes/corrections in RED ink or pencil. <br /> RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(dace) <br /> PRI-RP has been named a Primary RP. <br /> Business Name STOCKTON SCAVENGER ASSC.INC;, <br /> Contact AMY DIETZ <br /> Address P O BOX 6566 <br /> AUBURN,CA 95604 <br /> Phone <br /> 1 <br /> i <br /> I <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 ! / <br /> Report#8021 Date 6/15/2005 <br />