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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 �t } <br /> Case# 1072 , '' oo LtOn1u I <br /> Site Name EXXON#7-3708 <br /> [ N ',91 <br /> Location 2 T <br /> 705 COUNTRY CLUB BLVD `site Ib4i", _ <br /> /I ii ` y 9 <br /> STOCKTON,CA 95204 Fait <br /> 044 <br /> Phone209-465-4756 <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 EXXON MOBIL <br /> Contact JENNIFER SEDLACHEK <br /> Address 4096 PIEDMONT AVE#194 <br /> OAKLAND,CA 94611 <br /> Phone <br /> . ,� C ` <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 />