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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# 1665 j Local Agency Use Only <br /> Remedial Oversight <br /> Site Name I <br /> CHEVRON SER STA#9-1452 Record ID R00000135 <br /> Location 334 E MAIN ST Site Record ID SDO00013S <br /> RIPON,CA 95366 Facility Record ID FA0003714 <br /> Phone 209-599-2313 Current Site Business CHEVRON USA INC#91452* <br /> i <br /> APN 261-150-41 <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 /> si n and return this form. <br /> Make changes/corrections in RED ink or pengil. <br /> RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(date) t'A' <br /> PRI-RP has been named a Primary RP. <br /> Business Name CHEVRON TEXACO COMPANY G,u✓rc" S"Vl rp0 y"e U gijx e,%Cj CO <br /> Contact DARIN ROUSE r�) I L-- I 1�Ovse. <br /> Address PO BOX 6012 K2260 CEJ0C,> t x_a� y��,� ►��t'�n Rd i7gz�:)U <br /> SAN RAMON,CA 94583 ail y1ywcn, , C.A L 1 LIS <br /> Phone 9 ZT- `i Z I s-3 Z <br /> Other RP Address6091 CANYON RD BLDG V <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 beperformedin accordance with all applicable Ordinace Codes aandd//or Standards and State and/or Federal Laws. <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: e✓ro <br /> SIGNA RE: Date <br /> Report#8021 Date 6/15/2005 <br />