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r <br /> 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# 0001504 <br /> Site Name USA GAS <br /> Location 2705 COUNTRY CLUB <br /> STOCKTON,CA 95204 <br /> Phone <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 /> s' u and return this form. <br /> Make changes/corroctions in RFD Ink or pencil. <br /> RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(date) <br /> PRI-RP has been named a Primary RP. <br /> Business Name USA PETROLEUM COMPANY <br /> Contact CHARLES MILLER <br /> Address 30101 AGOURA CT.#200 <br /> AGOURA HILLS,CA 913914311 <br /> Phone (213)452-6200 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator,primary responsible party,or agent of same,acknowledge that all <br /> $ite,and/or project specfic,EHD hourly charges associated with this site will be billed to the party Identified as the PRIMARY RESPONSIBLE PARTY on this <br /> fort. i also certiy,that all operations will be performed in acxordance 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 />