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SAN JOI "NUIN COUNTY PUBLIC HEALTH ,'TRVICES <br /> P O Box 388*.. SrocKToN, CA 95201-0388 • Peon✓(209) 468-3420 <br /> ERNEST M. FUJIMOTO, M.D., M.P.H., ACTING HEALTH OFFICER <br /> DONNA HERRN, R.E.H.S., DIRECTOR, ENVIRONMENTAL HEALTH DIVISION <br /> ENVIRONMENTAL HEALTH <br /> I-FURATING FERAIT F&) t4&31ERGt -KWD STORAGE TAW, FACILITY <br /> Tank Tar* Permit. Annual Permit Fee Valid <br /> PIE Number Record In, 4m}ber Capacity Contents Permit Status From Te <br /> rso 04)2 TA197202 006679 1,500 Unleaded 02 Conditional Permit C /0119121 117— <br /> PERMIT CCINDITION'3: <br /> 1) The PERMIT TO OPERATE will become void if 4U& PERMIT Fees and SERVICE Fees are not paid andior the UST system(s) fails <br /> to remain in compliance with the PERMIT UNDI E% <br /> 2) The PERMIT TO OPERATE is granted to the TANK MER 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 County <br /> 3) The TANK OPERATOR(S), if different from the tank owner, shall operate and monitor the I)ST 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 T.K. OWNER shall notify the Environmental HEaith Division of any proposed change Jr. operation or ownership of the I)ST <br /> system. <br /> S) Upon any change in equipment, design of operation of this facility, the PERMIT TO OPERATE will be reviewed by the <br /> Environmental 4ealth Division. <br /> 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 con<idered permission to violate any existing laws, ordinances c* statutes of other <br /> federal, state or local agencies. <br /> 2) A "Conditional Permit' may be revoked if corrections are rat completed by the date(s) specified on inspection. <br /> PERMIT TO OPERATE an UST FACILITY issued to, PACIFIC BELL ENVIRONMENTAL MGT <br /> ='O BOX 1503:3/264F• WATT AVE #4 <br /> SACRAMENTO, CA 958S'i <br /> PERMIT= TO OPERATE and ANNUAL_ PERMIT FEE PAYMENTS are NOT TRANSFERABLE <br /> and n)ay be SUSPENDED or REVOKED for cause. <br /> THIS FORM MUST BF DISI"YED CONWICUOMLY ON THE PROMISES <br /> REGULATED FACILITY; PACIFIC BELL Account ID: 0003S85 <br /> 7644 N ASHLEY LN Facility ID; 00='367 <br /> ST00:70N, CA 95205 Permit Printed' 0',111 /95 <br /> BILLING ADDRESS: <br /> PACIFIC BELL <br /> ATTN: PERMIT DESK. <br /> \ PO BOX 1Sid:R/2646 WATT AVE #4 <br /> SACRAMENTO, CA 955.51 <br /> `` �/ *AN/ <br />