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is <br /> 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 /> Case# 0440887 �LocalE AgencLse(Only . <br /> Site Name QUIT{STOP MARKET#76Remedial Oversighif ' <br /> ' 1Record ID RO0000887 <br /> Location 1030 S OLIVE ST � Stke I?ecord 1>7` SD(}Op48'7 <br /> j <br /> STOCKTON,CA 95215 Facility Record II} FA0001060 ' <br /> Phoney -k, ;, I <br /> Ctacrenk 51fo slness�{�CU(K STEP MAii�' #7614 <br /> A P N 15726422 XM <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]thissite. If this billing information is not accurate, please make necessa chap es in the space provided, da <br /> I <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 QUIK STOP MARKETS <br /> Contact MIKE KAVELOT <br /> Address 4567 ENTERPRISE ST <br /> FREMONT,CA 95438-7605 <br /> Phone (510)657-8500 <br /> 1 <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 Ordinate Codes and/or Standards and State and/or Federal Laws. <br /> 1 <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date / ! <br /> Report#8021 Date 6!1512005 <br />