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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTNINECOW D <br /> LOCAL OVERSIGHT PROGRAM JUL _ 12005 <br /> Responsible Party Information as of 6/15/2005 <br /> KNrTaRMES <br /> LOP SITE FILE INFORMATION _ <br /> Case# 0001471 <br /> Local Agency Use Only <br /> Site Name BANTA TERMINAL'UST'SITE _ Remedial Oversight R00001471 ✓� <br /> Record ID <br /> Location 22888 KASSON RD Site Record ID SD0001471 <br /> TRACY,CA 95376 Facility Record 1D FA0003821 <br /> Phone 209-835-1097 Current Site Business CHEVRON-BANTA TERMINAL <br /> APN 239-060-17 <br /> The following information is currently on file with this Department. The Primal , Responsible Party <br /> identified below will be responsible for payment of invoices for direct oversight charges associated wJthissite. If this billing information is not accurate, please make necessary changes in the space provided, <br /> sign and return this form. <br /> Make changes/corrections in RED ink or pencil. <br /> RESPONSIBLE PARTY INFORMATION RP INFORMATION CHANGE(date) 130105_ <br /> PRI- RP has been named a Primary RP. n <br /> Business Name CHEVRON TEXACO ENV MGMT CO Clna.vrav,� Elny1rcmv-ne.h4A-) MQNaiew6Vll (:o <br /> Contact BOB COCHRAN D, `R6v.5er <br /> Address P O BOX 6004 l (Ir-N1 201110So? ' Q0A4 Q 9J. K22—&(7 <br /> SAN RAMON,CA 94583 Sao CA 0H5'9'3 <br /> 8.3 <br /> Phone (925)842-9655 915- <br /> ZS'-12 1542 <br /> f} Ob'0&7 I R <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: ID L TITLE: �rOjGc� �y�ltiCZr <br /> REPRESENTING: ZV► troy-, VCIU� t l COM Ah 1 <br /> SIGNA Date _/ / �5 <br /> Report#8021 Date 6/15/2005 <br />