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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 �✓r'� o <br /> .x ,s - <br /> Case# 1039 oa AencyKTJse y <br /> SR <br /> Rl'Y�7dt1C)ae SIC1�I� Y -max <br /> Site Name CHEVRON STATION#90557*** 4$6AR <br /> F ,' <br /> Re +3 , <br /> Location 139 S CENTER ST e e 13�Sfs <br /> �t �� r <br /> STOCKTON,CA 95202 acllltytrd�" �{ s <br /> Phone 209-467-1625 �� <br /> APN137 0012 <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 CHEVRON TEXACO COMPANY <br /> Contact DARIN ROUSE <br /> I <br /> i <br /> Address PO BOX 6012 K2260 <br /> SAN RAMON,CA 94583 <br /> Phone <br /> Other RP Address 6001 BOLLINGER CANYON RD BLDG V <br /> SAN RAMON,CA 94583 <br />�j <br /> I <br /> i <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 /> PRINTED NAME: TITLE: <br /> 1 <br /> REPRESENTING: <br /> I <br /> SIGNATURE: Date <br /> i <br /> Date 6/15/2005 <br /> Report#8021 <br /> i <br />