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I <br /> i <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 /> v ol �! t <br /> Case# 506313 F <br /> t <br /> Site Name <br /> SHELL SERVICE STATION <br /> Location 1071 N MAIN a F3e;rori �$ <br /> MANTECA,CA 95336 ecoCtt�D�Af?d0 4 <br /> Phone 209-823-5265t51L ,w5111eS r �4 sem'" <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 chanlzes 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 /> i <br /> CARSON,CA 96810-1039 <br /> Phone <br /> i <br /> I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,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 Ordinate Codes and/or Standards and State and/or Federal Laws. <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: 'Date <br /> I <br /> Report#8021 Date 6/15/2005 <br />