Laserfiche WebLink
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# 1952 dal' eCy 17se®rly �� <br /> Site Name CHEVRON STATION4M-7 * <br /> Location 2905 W BENJAMIN HOLT DR <br /> STOCKTON,CA 95207 Fa01i eda i _ AD0 1MW <br /> Phone 209-478-5555 Mit e fSt E3tstrieC C}N STAON#94 7 * , <br /> r 66 <br /> The following information is currently on�file wit-h.this,I)epartment.,,The:-Primarv-Responsible=Party--� _ <br /> r <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 CHEVRON TEXACO COMPANYtatVr �j�nv��-v+�m�tn+a,� art��,r�t� �L1. <br /> Contact DARIN ROUSE <br /> Address PO BOX 6012 K2260 <br /> SAN RAMON,CA 94583 c�llti r3">'1l5�t3 <br /> Phone <br /> Other RP Address LDG V <br /> �'R bdo"Z E-(a <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: ��� . \—o l"��t.�SC.� TITLE: pro�c.'-4 o�InG G� <br /> REPRESENTING: qv I r&, G4 Cow Vl! <br /> SIGNAT Date <br /> Report#8021 Date 6/15/2005 <br />