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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 5. <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> LOP SITE FILE INFORMATION <br /> Case# 1213 Local Agena.LKt,Qal <br /> Site Name UNOCAL#SS/2859 304 3 , Remedial Oversight Record ID 12[10000.85 <br /> Location 1665 PACIFIC AVE Site Rec opo p SDO000585 <br /> STOCKTON,CA 95204 Facility,l;t �r i 'FA0005998 <br /> Phone 415-945-7676 Current Site Business T-NION 011,SS#2859 <br /> APN <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 wJthissite. If this billing information is not accurate, please make necessarychanes in the space provided, <br /> sin and return this form. <br /> Make changes/corrections in REO ink or pent I. <br /> RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(date) t +� <br /> PRIRP has been named a Primary RP. 11 r <br /> Business Name Cke Vt"6n r.�lllltYO Cn I n�PQ <br /> Contact <br /> Address 0 In 1 r� Ca+1 n b rnp3 t7 <br /> 93406 <br /> Phone <br /> / rl <br /> ado OL 01��3 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,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 ail operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and State and/or Federal Laws. <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date 1 1 <br /> Report#8021 Date 6/15/2005 <br />