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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 <br /> Case# 1665Eli <br /> Site Name CHEVRON SER STA#9-1452 <br /> Location 334 E MAIN ST SU135 t ,. <br /> RIPON,CA 95366 y 11 tyeCcS 1 t <br /> Phone 209-599-2313 OM3i3 �# 4 .2 <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 /> r <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 /> Report#8021 Date 6/15/2005 <br />