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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 A-P—DO A1s I I <br /> Case# <br /> 1]g] Loc Aeei]cl Use Only <br /> Site Name UNION OIL SS#0187 (C keV r&rl fp3o y I Remedial Oversight " <br /> Record ID 800000582 <br /> Location 437 E MINER AVE Site Record ID SD0000582 <br /> STOCKTON,CA 95202 Facility Record ID FA0006007 <br /> Phone 415-945-7676 <br /> APN 13924017 <br /> The following information is currently on file with this Department. The Primary R=provided, <br /> identified below will be responsible for payment of invoices for direct oversight chais <br /> site. If this billing information is not accurate, please make necessary changes in th , <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 �.I'rtVfon hJrronrrie,. 4� 11'� p,M ew'�' �pmP.r..y. <br /> Contact JOJTN--FRM a 0 <br /> Address T-p-BOXT"g U <br /> I�OOI �nl�Inv<�• Cnar��raCr, (Zd Roo✓+,k. 2DSb <br /> _c�*rlliiC n�ciPn �'• nom• .So�.v. IC_p�yYtQr� l-A l 1.452 <br /> Phone <br /> A <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 />