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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 <br /> Case# 1058124;; <br /> Site Name INTERSTATE SHELL <br /> h. S•� j 4 P M i <br /> Location 620 W CHARTER WAY fde 4 2 R � <br /> STOCKTON,CA 95206 ' " <br /> WS f <br /> R <br /> Phone 209-948-4315 .CI �R yt}gy " <br /> � qC�+ <br /> � I <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 SHELL O'I'L PRODUCTS US <br /> Contact DENIS L BROWN <br /> Address 20945 S WILMINGTON AVE <br /> CARSON,ICA 90810-1039 <br /> Phone <br /> i <br /> I <br /> If <br /> i <br /> i <br /> i <br /> I <br /> i <br /> A4koo alR(o7a '! f <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 /> I. i <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: I j <br /> i <br /> SIGNATURE: Date <br /> f <br /> Report#8021 Date 6/15/2005 <br /> V <br />