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SAN JOAQUIN COUNTY ENVIRONMENTAL'HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> r � } <br /> 't. i! <br /> LOP SITE FILE INFORMATION <br /> T <br /> r • Lia''1,�S�ekacit` S�l"�,,,� .. i <br /> Case# 1417 <br /> Site Name SHELL OIL CO* 1fd 1 �' <br /> Location 3725 N TRACY BLVD <br /> TRACY,CA 95376 <br /> Phone 209-957-5398 ' <br /> The following information is currently on file with this Department. The Primary ty <br /> Responsible Par <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 /> si n and return this form. - <br /> -a <br /> Make changeslcorrections in RED ink or pencil <br /> RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(date) <br /> ,y PRI-'RP has been named a Primary RP. <br /> Business Name SHELL OIL PRODUCTS US <br /> Contact DENIS L BROWN <br /> Address 20945 S WILMINGTON AVE <br /> CARSON,CA 90810-1039 <br /> Phone <br /> .i <br /> i <br /> i <br /> �}R no aFs (P [ ; <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator,primary responsible party,or agent of same,acknowledge that all <br /> site,andlor 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 Ordinate Codes and/or Standards and State and/or Federal Laws. <br /> PRINTED NAME: TITLE: } <br /> REPRESENTING: <br /> SIGNATURE: Date ! 1 <br /> Report#8021 Date 6/15/2005 <br /> I <br />