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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 If ) p7p Local Aesaoy Qk Only <br /> Remedial Overalght <br /> Site Name SHELL OIL COMPANY-EQUIVA RaccYd ID., R00060484 ' - <br /> Location 2575 COUNTRY CLUB BLVD Sita Rgcord ID SD00I]l <br /> STOCKTON, CA 95204 r Facility Rec6rdl ID , F.A0006439 <br /> Phone 209-948-0574 Current Site Business 'COUNTRY CLUB SHELL, <br /> APN 123-020-12 <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 OIL PRODUCTS US <br /> Contact DENIS L BROWN <br /> Address 20945 S WILMINGTON AVE <br /> CARSON, CA 90810-1039 <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: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date <br /> Report # 8021 Date 6/15/2005 <br />