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SAN JOAQ& COUNTY PUBLIC HEALTH SLICES <br /> P O Box 388 • TmKToN, CA 95201-0388 • PHONE (M) 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 /> TING PEFOCIT FUR UMERGRMM STORA61E TAW, FACILITY <br /> Tank Tark Permit Annual Permit Fee Valid <br /> P/E Number Record 10 Number Capacity Contents Permit Status Frca To <br /> 2315 007 TAW6059 048533 12,000 Unleaded 01 Active Permit 01/01/97 12/31/97 <br /> 2315 005 TA546057 008SU 12,000 Unleaded 01 Active Permit 01/01/97 i2/31/97 <br /> 2315 005 TA506058 008535 12,000 Unleaded 01 Active Permit 01/01/97 12131/97 <br /> PERMIT C OND I T I ONS: <br /> 1) The PERMIT TO OPERATE will become void if ANNUAL PENT Fees and NICE Fees are not paid and/or the UST system(s) fails <br /> to' remain in compliance with the PERMIT CONDITIONS. <br /> 2) The PERMIT TO GRATE is granted to the TANK OWNER 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 Sari Joaquin County. <br /> ?) The TANK OPERATOR(S), if different from the tank owner, shall operate and monitor tte UST system according to the WRITTEN <br /> OPERATING AGREEMENT required under Section 25293, Chapter 6.7, Division 20, California Health and Safety Code, <br /> 4) The TAW OWNER shall notify the Environmental Health Division of any proposed change in operation or ownership of the UST <br /> system. <br /> 5) Upon any change in equipment, design or operation of this facility, the PERMIT TO OPERATE will be reviewed by the <br /> ff Environmental Health Division. <br /> 4 6) A construction or removal permit is required from the Environmental Health Division prior to any removal or <br /> change of UST system equipment. <br /> 7) This PERMIT TO OPERATE shall not be considered permission to violate any existing laws, ordinances or statutes of other <br /> federal, state or local agencies. <br /> PERMIT TO OPERATE an UST FACILITY issued to: KEN PAIGE <br /> 236 M HAM LADE <br /> LODI , CA 9 240 <br /> PERMITS TO OPERATE and ANNUAL PERMIT FEE PAYMENTS are; NOT TRAP):IFERAL LE <br /> and may be SUSPENDED or REVOKED for cause. <br /> THIS FOM WJST BE 019PLAVED C04SPICWJSLV ON THE PREMISES <br /> REGULATED FACILITY: LAKEWOOD CHEVRON USA #4183* Account ID; 0002290 <br /> ' <br /> :v WN Facility ID, W3711 <br /> W- -11---11r1-A':'° 95240 Permit Printed: 03/28/97 <br /> BILLING AWSS; LAKEWOOD CHEVRON USA #4183# <br /> ATTN: k`EN PAIGE <br /> 236 N HAM LN <br /> LODI , CA 95240 <br /> r <br />