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3HIV~av U1P4 l.VU1V1Y L'1V V11CV1V1V1L'1V1HL nr.F11'1h Lr.i"HK11V1z1`I1 <br /> O <br /> ,,,LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 8/8/21 <br /> LOP SITE FILE INFORMATION <br /> Case# 1173 <br /> Local Agency Use Only <br /> Site Name BEACON 9474 Remedial Oversight R00000066 <br /> Record ID <br /> Location 3440 E MAIN ST Site Record ID SD0000066 <br /> STOCKTON,CA 95205 Facility Record ID FA0006423 <br /> Phone 209-463-7716 Current Site Business UNITED GAS <br /> APN 15716002 <br /> L---------------------------------- <br /> The <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 ULTRAMAR INC LLWA rn" L*L+�,'1� /`' (_ ^ . ± i�`�7L <br /> U /� <br /> Contact ROB FISHBRN `Gbt: Srt� /wj r l �i�" <br /> Address 685 W THIRD ST Lf"2 Vajr� w <br /> HANFORD,CA 93230 JAJ� knJVK" "7—k- -70 ;I-qq <br /> Phone <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 8/8/2011 <br />