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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# 1995123 <br /> Site Name BP/TOSCO.#11192/CIRCLE K o eO ii 0 <br /> Location 1403 W COUNTRY CLUB BLVD f etrtsli s 8 y <br /> r � <br /> STOCKTON,CA 95204 � cl I e 1 I A01, a <br /> s d �.�j v� <br /> Phone 209-943-2082 ttTt S ust t?�#2'7054 <br /> N" ' <br /> S l , <br /> uC 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 chanEes 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 CONOCOPHILLIPS <br /> Contact EDWARD RALSTON <br /> Address 76 BROADWAY <br /> SACRAMENTO,CA 95818 <br /> Phone (916)714-2910 <br /> II <br /> i <br /> i <br /> 3 ' <br /> V <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 /> f <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> Date <br /> SIGNATURE: <br /> I <br /> Report#8021 Date 6/15/2005 <br />