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I <br /> 1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> i� <br /> LOP SITE FILE INFORMATION <br /> Case # 2261 Local Asency Use Only <br /> Site Name Remedial Oversight <br /> TOSCO (FORMERLY CIRCLE K) Record ID 800000558 <br /> Location 8606 THORNTON RD Site Record ID SD0000558 . <br /> STOCKTON, CA 95209 Facility Record ID FA0007934 . <br /> Phone 209-956-4040 Current Site Business CIRCLE K #8671 <br /> APN 072-420- 19 <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 chances in the space provided , date, <br /> sign and return this form . <br />:I <br /> Make changes/corrections in RED ink or pencil. <br /> j 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 /> Q <br /> I <br /> 3 <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 /> Report # 8021 Date 6/15/2005 <br />