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SAN JOA&UIN COUNTY PUBLIC HEALRVICES <br /> P O Box 3881W S' MKMN, CA 95201-0388 • PHo (209) 468-3420 <br /> ERNEST M. FUJIMOTO, M.D., M.P.H., ACTING HEALTH OFFICER <br /> DONNA RERAN, R.E.H.S., DIRECTOR, ENVIRONMENTAL HEALTH DIVISION <br /> ENVIRONMENTAL HEALTH <br /> OPERATING PERMIT FOR UNDERGROUND STORAGE TANK FACILITY <br /> Tank Tai Permit Annual Permit Fee Valid <br /> PIE fiber Record ID mer Capacity Contents Permit Status From To <br /> iF <br /> 2 �3 TAl i�?3 1 5118 51( Unleaded 41 Active Permit '+ 01/0165 12/31/§5 <br /> i <br /> i <br /> .PERMIT CONDITIONS: <br /> 1) The PERMIT TO !MATE will become void if WM PERMIT Fees and SERVICE Fees are not paid and/or the !S+i system(s) fails <br /> to remain in compliance with the PERMIT CONDITIONS. <br /> 2) The PER14IT TO OPERATE is granted to the Tom: OAR who accepts responsibility for operating and monitoring the UST system <br /> according to State underground storage tank laws and regulations as well as any conditions established by San Joaquin ty. <br /> 3) The TANK OPERATORS), Af different from the tank owner, shall operate and monitor the UST system according to the WRITTEN <br /> OPERATING K40MT required under Section 25253, Chapter 6.7, Division 20, California Health and 'safety Code. <br /> 4) The TANK DAR shall notify the Environmental Health Division of any prop+so change in operation or ownership of the UST <br /> system. <br /> 5) Upon any change in equipment, design or operation of this facilitz, the PERMIT TO OPERATE will to reviewed by the <br /> Environmental Health Division. <br /> 5) A construction or removal permit is required from the Environmental Health Division prior to any rMoval or <br /> change of UST system equipment. <br /> 7) This PIT TO OPERATE shall riot be considered permission to violate any existing lamas, ordinances or statutes of other <br /> federal, state or local agencies. <br /> PERMIT TO OPERATE an UST FACILITY issued to; LOD I MEMORIAL HOSPITAL <br /> 975 S FA T.RMONT <br /> LODI , CA 94240 <br /> PERMITS TO OPERATE and ANNUAL PERMIT FEE PAYMENTS are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED f t r cause. <br /> THIS FOM MUST BE DISPLAYED CMS'IC*LXk1SL.IP ON THE RISES <br /> RERLATED FACILITY; LCD 1 MEMORIAL HOSPITAL Account ID: 0001")512 <br /> 975 S FAIRMONT Facility IDS 000513 <br /> LODI , CA 9440 Permit Prirtedi 08/11 /95 <br /> BILLING ADDRESS: <br /> LOD I MEMORIAL HOSPITAL <br /> ATTN: FACILITY MANAGEMENT <br /> PO BOX 3004 <br /> l04 <br /> L,WAC T. , CA 9S241 <br /> a � <br />