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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 /> � ddafiAe rlSsabnly; - ' � <br /> Case# ]176 ReFned �t�ve gayh � y83 I <br /> Site Name UNOCAL#5886 .ReGOftl 1Gi „k I <br /> Location 2701 W MARCH LN ifa.Ft D' S`ICCipil.0583`' <br /> STOCKTON,CA 95219 iiclllty gets Id F��71 '. <br /> Phone 209-473-7337 ir1fM.1`8ttt-StidBUSir!gsst,'q,RCHS, 'IN.C9IL1s0 <br /> PN:' 11Cr 1451€1 ` <br /> The following information is currently on file with this Department. The Primary Responsible Party <br /> 4 <br /> identified below will be responsible for payment of invoices for direct oversight charges associated with this <br /> I <br /> { site. If this billing information is not accurate, please make necessary changes in the space provided,date, <br /> sin 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 CONOCOPHILLIPS - <br /> Contact SP <br /> Address 76 BROADWAY <br /> SACRAMENTO,CA 95818Phone <br /> (0) <br /> 1 -L {-(I) SJd r710� I <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 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 6/15/2005 <br /> v <br />