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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> ;I <br /> I <br /> LOP SITE FILE INFORMATION _pr 01 <br /> +.! <br /> Case# 1995123 I mAv IV <br /> y z, 4 a <br /> Site Name BP/TOSCO#11192/CIRCLE K 0000087' <br /> Location 1403 W COUNTRY CLUB BLVD ., 170000087 k <br /> r <br /> STOCKTON CA 95204 I 1 <br /> Phone 209-943-2082 <br /> The-following_information_is.currently.on,ci e-with�th_is D .art 1:: The -rima-ry P.sponsible P.a-rfty� <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 p nc't. <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 <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: � `\��--5`� TITLE: J 1 TE M Gl(L -- <br /> REPRESENTING: �tk <br /> SIGNATURE: Date / 2-8- <br /> / 6� <br /> Report#8021 Date 6/15/2005 <br />