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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPAR",r-"'i-4f <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> LOP SITE FILE INFORMATION <br /> Case# <br /> 1057 Local Apenc <br /> Site Name CHEVRON#92033'" Remedial Oversight <br /> Record ID 800000123 <br /> Location 508 W CHARTER WAY I ' Site Record ID SD0000123 ' <br /> STOCKTON,CA 95206 Facility Record ID FA0003720 <br /> Phone 209-465-3440 <br /> APN 165-04-016 <br /> The following information is currently on file with this Department. The Primary=provided, <br /> identified below will be responsible for payment of invoices for direct oversight chis <br /> site. If this billing information is not accurate, please make necessary changes in t , <br /> sign and return this form. <br /> RESPONSIBLE PARTY INFORMATION Make changestcorrections in RED ink or peny'1. <br /> RP INFORMATION CHANGE(date) (old/OS <br /> PRI-RP has been named a Primary RP CC <br /> Business Name CHEVRON TEXACO COMPANY L .�'lOIA'iOYy Lt3 trQnrtv�w�n M.tyyNfitNte� CO <br /> Contact DARIN ROUSEy f ,,h.�� FLO.�..Q�,� <br /> Address PO BOX 6012 K2260 /// 3olhn�en �,v,ygra �2m 3b52 <br /> SAN RAMON,CA 94583 Sow1 t�vlonlSA 9ys6i�— <br /> Phone, <br /> 92sy 3 a s�9 <br /> Other RP Address 6001 BLDG V <br /> SAN�RAMON,C'e 24MJ- <br /> A "2oo aeco58- <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 /> D <br /> PRINTED NAME: ��7V�� - L • (1Uy5ti TITLE: PFOtcc� -i �L�I:y,Typ� <br /> REPRESENTING: (2YI(.Vrv^ �1 <br /> SIGNAT Date <br /> Report#8021 <br /> Date 6/152005 <br />