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r � <br /> SAN JOAQUIN COUNTY ENVIR%� NMENTAL HEALTH DEPARTMENT <br /> LOCAL OVERSi 3HT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> LOP SITE FILE INFORMATION 3S <br /> Case# 507198 Local Agency Use Only <br /> Y,: Remedial Oversight <br /> Site Name CIRCLE K,TOSCO,UNOCAL#01205 Record ID 800000138 <br /> Location 16470 S CAMBRIDGE DR [., Site Record ID SD0000138 <br /> LATHROP,CA 95330 Facility Record ID FA0007732 _ <br /> Phone Current Site Business TOSCO h1ARKETING CO(CIR <br /> APN 19643016 <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 CONOCOPHILLIPS <br /> Contact EDWARD RALSTON <br /> Address 76 BROADWAY <br /> SACRAMENTO,CA 95818 <br /> Phone (916)714-2910 <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: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date <br /> Report!18021 Date 6/152005 <br />