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SAN JOAQUIl`,�UNTY ENVIRONMENTAL HEALTH D' RTMENT <br /> LOCAL OVERSIGHT PROGRAM. <br /> Responsible Party Information as of 2/18/2009 <br /> LOP SITE FILE INFORMATION <br /> v � <br /> kZ <br /> f focal ncy[xse Ity <br /> Case# 0001322 <br /> g eniedle �etrh b001L. � � <br /> Site Name LOW PRICE AUTO GLASS <br /> 15. <br /> Pik <br /> Location- 3978 S HWY99 RTE <br /> STOCKTON,CA 95205 <br /> Q. <br /> Phone 209-948-4975 <br /> "2"N <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 R.P. <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 /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,`o'perator,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.b'illed 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 /> I <br /> i <br /> Report#8021 Date 2/18/2009 <br />