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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Par Information as of 6/15/2005 <br /> P h' <br /> LOP SITE FILE INFORMATION <br /> Case# 1760vp <br /> 1'$Ayse by' <br /> Site Name teretal estgtA'" <br /> WATERLOO SHELL '` � <br /> Location 4315 WATERLOO RD St orc3 to"" x <br /> STOCKTON,CA 95205 ;c1iy203 <br /> Phone 209-957-5398 Cutrenta�rte"B I '3EaQ SHELT. <br /> X08 1U ' <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 /> I . <br /> i�Ooa�(p1� <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 /> t Report#8021 Date 6/15/2005 <br /> i <br /> i <br /> i <br />