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SAN JOAQUI14 +AUNTY ENVIRONMENTAL HEALTH D` kRTMENT <br /> i <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 2/18/2009 <br /> I <br /> LOP SITE FILE INFORMATION <br /> -7 <br /> a17 <br /> Local A�ercY <br /> Case# 0001322 <br /> F Remedtal Oversight <br /> Site Name LOW PRICE AUTO GLASS °.flecord'ID R0000132 <br /> •'P <br /> Location 3978 S HWY 99 RTE Stte,Record ID SI30001322 <br /> STOCKTON,CA 95205 l I <br /> Phone 209-948-4975 ( �" <br /> Z <br /> a APN sem]7, 1710 x <br /> t <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 /> sign 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 LOW PRICE AUTO GLASS <br /> Contact SANDRA YACOUB <br /> Address 3978 S.HWY 99 E FRONTAGE ROAD <br /> STOCKTON,CA 95205 <br /> Phone (209)948-4975 <br /> PRI-RP has been named a Primary RP <br /> Business Name CHEVRON ENVIRONMENTAL MGMT CO <br /> Contact STEPHANIE FURGAL <br /> Address 6001 BOLLINGER CANYON RD RM K2240 <br /> SAN RAMON,CA 94583 <br /> Phone (925)842-1466 <br /> �.'tfl•y.iiM1 '.bit.-, + .,t Malys.-v 4+I.s S fib.: i h'•i..a •..� �u� �3} .'s"i,, �+.(•.•r r�+t.,'- . <br /> a ...9.^L.^•tt.1s }SZV^ .,b?Sev.. ,Y:.x'M+.>.,+.•. ;....,.}'.•._♦ ... . ,.-'\S''F'"f•'1.... ^t JR'i:�.v°[ <br /> a <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner, operator,primary responsible party, or agent of same,acknowledge that all j <br /> site,and/or project specific,EHD hourly charges associated with this site will be billed to the party identified as the PRIMARY RESPONSIEI-E 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 /> i <br /> SIGNATURE: Date <br /> Report#8021 Date 2/18/2009 <br />