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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# 1356 L Ueai A ttcy Use OM <br /> Site Name USA PE'T'ROLEUM CO <br /> e ke ers <br /> al tght <br /> rtecord;.l , k000005-90 I <br /> Location 2500 W LODI AVE 'ode R: fdI7`, {j0y <br /> LODI,CA 952401alljty'RoM It7 Ik00 .815 <br /> Phone 209-333-9834 60eCtt S ,tdtR3nt:3s USA,GAStII INl3#65' <br /> APN, � - 44.7 <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 USA PETROLEUM COMPANY <br /> Contact CHARLES MILLER <br /> Address 30101 AGOURA CT.#200 <br /> AGOURA HILLS,CA 91301-4311 <br /> Phone (213)452-6200 <br /> f}4k6o a'E"'409q <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator,primary responsible party,or agent of same,acknowledge that all <br /> site,andlor 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 Ordinate Codes and/or Standards and State and/or Federal Laws. <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date / 1 <br /> Report#8021 Date 6/1512005 <br />