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SAN JOA&IN COUNTY PUBLIC HEALTH I&VICES <br /> P O Box 388 MW STocRTON, CA 95201-0388 • PHONE 09) 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 /> IVERATIN6 PERMIT FOR k#40ERGROLM STORAGE TAW FACILITY <br /> Talc Tank Permit Annual Permit Fee Valid <br /> P/E !fir Record ID Number Capacity Contents Permit Status From To <br /> `r'?80 003 TA133103 OOS118 5,000 Diesel 01 Active Per-'At 01!01197 12/31/97 <br /> PERMIT CONDITIONS: <br /> 1) The PERMIT TO OPERATE will become void if AWAL PERMIT Fees and SERVICE Fees are not paid and/or the LIST system(s) fails <br /> to remain in ccepliance with the PERMIT CONDITIONS. <br /> 2) T!e PERMIT TO OPERATE is granted to the TANK 00 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 ovner, shall operate and monitor the 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 TAM+tMt OWNER shall notify the Environmental Health Division of any propDsed change in operation or ownership of the l)ST <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 /> Environmental Health 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 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, LOD I MEMORIAL HOSPITAL <br /> 97S S FA I RMONT <br /> LOM , CA 94440 <br /> PERMIT'S TO OPERATE and ANNUAL PERMIT FEE PAYMENTS are NOT TRANSFERABLE <br /> and may be: SUSPENDED or REVOKED for cause?. <br /> THIS FORM MMT BE 1DISPLAYMEDICWJSL.Y ON THE PREMISES <br /> ;ENPLATED FACILITY: LOD I MEMORIAL HOSPITAL Account ID; 0000512 <br /> �- 4w Facility ID: OWS13 <br /> LODI , CA 94240 Permit Printed; 03128/97 <br /> BILLING ADDRESS: LOD I MEMORIAL HOSPITAL <br /> ATTN: FACILITY MANAGEMENT <br /> 'PO BOX 3004 <br /> LOD I . CA 95241 <br /> <, n e <br />