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SAN JOAQUIN COUNTY ENVIRONMENT.AL HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Informatio as of 6/15/2005 <br /> LOP SITE FILE INFORMATION �� <br /> 4 <br /> ,fid �i?Ii1i" "r9'-, <br /> jk <br /> Case# 0001536 <br /> :A <br /> Site Name <br /> USA PETROLEUM#3696 i 13 ,N <br /> 2448 W KETTLEMAN LN e 0. I ¥ <br /> Location t� <br /> fps^ <br /> LODI,CA 95240I ' C ,'1c0 '=: = ; <br /> Phone 209-369-3124 <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 necessaEy changes in the space provided,date, <br /> s$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 Prima RP. <br /> Business Name TESORO PETROLEUM COMPANY <br /> Contact JEFFREY BAKER <br /> Address 3450 SOUTH 344TH WAY STEJro 2� <br /> AUBURN,WA 98001 <br /> Phone <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operate',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 tote 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 rdinace Codes and/or Standards and State and/or Federal Laws. <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date I / <br /> Report#8021 Date 6/15/2005 <br />