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�I - <br /> WSAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> LOP SITE FILE INFORMATION <br /> Case # 1408 Local Agency Use Only <br /> Site Name Remedial Oversight <br /> CHEVRON .. Record l0 R00000119 <br /> Location 575 W GRANT LINE RD Site Record ID SD0000119 <br /> TRACY, CA 95376 Facility Record ID FA0003723 <br /> Phone 209-835-7900 Current Site Business CHEVRON STATION #98632 <br /> APN 214-490-03 <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 CHEVRON TEXACO COMPANY <br /> Contact DARIN ROUSE <br /> Address PO BOX 6012 K2260 <br /> SAN RAMON, CA 94583 <br /> Phone <br /> Other RP Address 6001 BOLLINGER CANYON RD BLDG V <br /> SAN RAMON, CA 94583 <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 Ordinate Codes and/or Standards and State and/or Federal Laws. <br /> PRINTED NAME: TITLE: <br /> REPRESENTING: <br /> SIGNATURE: Date <br /> j Report # 8021 Date 6/15/2005 <br />