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SAN JO#AUIN COUNTY PUBLIC HEALTH &VICES <br />304 E. WEBER AVE., THIRD FLOOR • STOCKTON, CA 95202 • PHONE (209) 468-3420 <br />KAREN FURST, M.D., M.P.H., HEALTH OFFICER <br />DONNA RERAN, R.E.H.S., DIRECTOR ENVIRONMENTAL HEALTH DIVISION <br />ENVIRONMENTAL HEALTH <br />SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY <br />PERMIT TO OPERATE <br />Code and Description <br />23 California Code of <br />To <br />2360 6 390002314820504845 F'IUuurrec <,00c UNLEADED Active DOUBLE WALLED <br />2360 5 390002314820504845 PT0007197 6,768 DOUBLE WALLED <br />2362 4 390002314820504844 PT0007196 2,632 UNLEADED Active <br />Underground Storage Tank Permit Conditions <br />I) The Permit to Operate win become void if Annual Permit Fees and Service Fees am not paid and/or the UST systems) fails to remain in compliance with these Permit <br />Conditions. <br />2) In order to maintain the operating permit, the permit holder shall comply with the H@.S Code, Div. 20, Chap. 6.7 and 6.75; and CCR, Title 23, Chap. 16 and 19, as we as <br />any conditions established by San Joaquin County. <br />3) If the Tank Operatar(s) is differmt from the Tank Owner, or if the Permit to Operate is issued to a person other than the owner or operator of the tank, the Permittee shall <br />ensum that both the Tank Owner and tank Operator receive a copy of the permit. <br />4) Written MonitoringPmcedures and an Emergency Response Planmust be approved bythe Environmental Health Division(PHS/EHD) andare considereid UST Permit <br />Conditions. Copies of the Procedures and Emergency Response Plan must be attached to this permit or be available for review and/or inspection at the USF site. <br />5) The Permittee shall comply with the monitoring procedures referrenced in this permit. <br />6) The Permittee shall perform testing and preventive maintenance on all leak detection monitoring equipment annually, or mom frequentlyif specified bythe equipment <br />manufacturer, andprovide documentation ofsuch servicingto this office. <br />7) In the event of a spill, leak, or other unauthorized release, the Permitee shall complywith the requirements of Title 23 CCR, Chap. 16, Art. 5, and the approved Emergency <br />Response Plan. <br />g) Written records of all monitoring performed shorn be maintained on-site bythe operator and be available for inspection fora period of at least three Was from the date the <br />monitoring was performed. <br />9) The PHS/EHD shall be notified of any change in ownership or operation of the UST system within 30 days of such change. <br />10) Upon any change in equipment, design or operation of the USr system (including change in tank contents or usage), the Permit to Operate will be subject b review, <br />modification or revocation. <br />11) Construction, repair and/or removal permits are required from the PHS/EHD prior to any change, repair or removal of UST system equipment. <br />12) The Permittee shall submit an annual report documenting compliance with the UST Permit Conditions within 30 days of the anniversary date ofthe issuance oftbis permit. <br />13) This Permit to Operate shall not be considered permission to violate any laws, ordinances or statutes of any other Federal, State or Local agency. <br />14) A "Conditional" Permit may be revoked if corrections specified on the inspection report are not completed by the date(s) indicated. <br />PERMITS TO OPERATE are NOT TRANSFERABLE <br />and may be SUSPENDED or REVOKED for cause. <br />e rwenr <br />PERM I I (S) vauD only tor. mHvaor., ..���� -••-__ <br />DBA: MADSENS SUNRISE DAIRY <br />THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br />Facility ID FA0000720 <br />Regulated Facility: MADSEN'S SUNRISE DAIRY Account ID AR0000719 <br />239 S STOCKTON ST Issued 312912001 <br />RIPON. CA 95366 <br />Billing Address: ATTN : MADSEN, ROBERT <br />MADSEN'S SUNRISE DAIRY <br />239 S STOCKTON <br />RIPON, CA 95366 is <br />7azs.rpt <br />