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� � <br /> ' <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> LOP SITE FILE INFORMATIONMR <br /> 35j(o <br /> Case# 505602 'Local A,geney-Use Only <br /> Site Name BANK OF THE WEST-firRemedial Oversightmr SHELL Record I ? R00000062 <br /> Location 1267 COUNTRY CLUB BLVD Site Record ID 4D0000062 <br /> STOCKTON,CA 95204 Facility Record ID FA0006891 <br /> Phone 510-942-8367 Cti-rent Site Busir)ess BANK til'TELE WEST <br /> APN 113-0432-17 Awk <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 necessary changes in the space provided,date, <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 SHELL OIL PRODUCTS US <br /> Contact DENIS L BROWN <br /> Address 20945 S WILMINGTON AVE <br /> CARSON,CA 90810-1039 <br /> Phone <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 /> Renort*sn21 rate fin 5/100 <br />