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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 /> I � <br /> Case# 000692 <br /> Site Name AIRPORT SHELL* Iu;< <br /> Location 1313 ECHARTER WY .in <br /> STOCKTON,CA 95205 I` i <br /> Phone <br /> 209-948-4315 it <br /> i <br /> The following information is currently on file with this Depart ent. 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. I <br /> flake changeslcorrections in RED Ink or pencil. <br /> RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(date) <br /> PRI-RP has been named a Primai-y RP. <br /> BuslneSS,Name SHELL OIL PRODUCTS US I <br /> Contact DENIS L BROWN <br /> I <br /> Address 20945 S WILMINGTON AVE <br /> CARSON,CA 90810-1039 <br /> Phone <br /> i <br /> 1 <br /> i <br /> it <br /> I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator primary responsible party,or agent of same,acknowledge that all <br /> site,andlor project specific,EHD hourly charges associated with this site will be billed tote 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 rdinace Codes and/or Standards and State and/or Federal Laws. <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date I 1 <br /> I <br /> Report#8021 Date 6/1512005 <br />