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% <br /> SAN JOAQUIN.COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> I <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> LOP SITE FILE INFORMATION X2(0 <br /> i <br /> Case# 1995123 , dce IV, Xd-f i <br /> PAW, e 1e�(Sers h <br /> Site Name ''BP/TOSCO#11192/CIRCLE Keco <br /> D. <br /> Location '1403 W COUNTRY CLUB BLVD <br /> STOCKTON,CA 95204 Faculty eco IA6 <br /> Phone 209-943-2082 mitt Srte �� �� <br /> pN : 66Z. <br /> r. k <br /> i <br /> The following information is currently on file with this Department. The Primary Responsible Part* <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 CONOCOPHILLIPS <br /> Contact EDWARD RALSTON <br /> Address 76 BROADWAY <br /> SACRAMENTO,CA 95818 <br /> Phone (916)714-2910 <br /> i <br /> j' <br /> i <br /> i <br /> i <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 PARRY on this <br /> I 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 /> p PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date <br /> Report#8021 Date 6/15/2005 <br /> i <br /> l V <br />