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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 3C✓a"� <br /> Case# 0001588 Loral„Assoc ,,,ilse Qnly <br /> 7 <br /> Remedial Oversight <br /> Site Name UNIVERSAL FOREST PRODUCTS Record Ip;<R0000001588 w <br /> r <br /> Location 26200 NOWELL RD Site Record ID"SDOOO <br /> THORNTON,CA 95686 Facility Record ID '1 A00¢9531 <br /> Phone 209-794-2303y <br /> C APN :x0012302f) A r o <br /> i <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. j <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 UNIVERSAL FOREST PRODUCTS <br /> Contact MATTHEW MISSAD - <br /> Address 2801 E BELTLINE <br /> GRAND RAPIDS,MI 49525 <br /> Phone <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 Ordinal a Codes and/or Standards and State and/or Federal Laws. <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date / 1 <br /> Report#8021 Date 6/1 512 00 5 <br />