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SITE INFORMATION AND CORRESPONDENCE FILE 2
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0544591
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SITE INFORMATION AND CORRESPONDENCE FILE 2
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Last modified
6/21/2019 7:17:12 PM
Creation date
6/21/2019 11:37:47 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
FileName_PostFix
FILE 2
RECORD_ID
PR0544591
PE
3526
FACILITY_ID
FA0005220
FACILITY_NAME
CHEVRON #9-4054
STREET_NUMBER
2103
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12308029
CURRENT_STATUS
02
SITE_LOCATION
2103 COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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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# 1780 <br /> Local Agency Use Only <br /> L Remedial Oversight <br /> Site Name CHEVRON USA 49-4054(former) Record ID R00000635 <br /> Location 2103 COUNTRY CLUB BLVD Site Record ID SD0000635 <br /> STOCKTON,CA 95204 Facility Record ID FA0005220 <br /> Phone 925-842-9655 ;'::Current Site Business CHEVRON 49-4054 <br /> APN 123-080-29 <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 CHEVRON TEXACO COMPANY <br /> Contact DARIN ROUSE <br /> Address PO BOX 6012 K2260 <br /> SAN RAMON,CA 94583 <br /> Phone <br /> Other RP Address 6001 BOLLINGER CANYON RD BLDG V <br /> SAN RAMON,CA 94583 <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: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date <br /> Report#8021 Date 6/15/2005 <br />
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