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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DE ARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 8/8/2011 <br /> LOP SITE FILE INFORMATION <br /> Case# 1756 Local Agency Use Only <br /> Remedial Oversight <br /> Site Name BEACON#419(OLYMPIC GAS) Record ID 800000067 <br /> Location 2350 E WATERLOO RD Site Record ID SD0000067 <br /> STOCKTON,CA 95205 Facility Record ID FA0006343 <br /> Phone 209-462-4569 Current Site Business ALPHA FAST GAS* <br /> - - APN 14118221 <br /> L <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 chanes 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 ULTRAMAR INC <br /> Contact STEVE COODEY <br /> Address 685 W THIRD ST <br /> HANFORD,CA 93230 <br /> Phone (559)583-3345 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator,primary responsible party,or agent of same,acknowledge that all site, <br /> 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 form. I <br /> 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 8/82011 <br />