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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 304 E.Weber Ave.,Third Floor• Stockton,CA 95202-2708• Phone(209)468-3420
<br /> Donna Heran,RE.H.S., Director
<br /> ENVIRONMENTAL HEALTH
<br /> SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY
<br /> PERMIT TO OPERATE
<br /> Program Permit
<br /> Record ID Number Program Code and Description Permit
<br /> Valid
<br /> PR0518923 PT0012257 2220-SMALL QUANTITY HAZARDOUS WASTE GENERATOR FACILITY 1/1/2004 To 12/31/2004
<br /> rya>argou5 Waste Generator Program
<br /> In order to maintain the permit to operate,Hazardous Waste Generators shall comply with California Health and Safety Code,Div.20,Chap.6.5,Art.2.13,
<br /> Sec,25100 et_seq,.and Title 22,California Code of Regulations,Chap_20. -
<br /> PR0516736 2300-UNDERGROUND STORAGE TANK FACILITY 1/1/2004 To 12/31/2004
<br /> Underground Storage Tank Program,
<br /> California Health and Safety Code,Div.20,Chap. and Title 23,California Code of Regulations,Chap_16. _
<br /> P/E Tank# Tank Record ID Permit# Capacity CoWents Permit Status System Type Leak Detection
<br /> 2360 3 . 390005167360515559 PT0011474 10,000 REGULAR UNLEADED Active,billable DOUBLE WALLED Continuous Interstitial Monitoring
<br /> 2360 2 390005167360515558 PT0011473 10,000 REGULAR UNLEADED Active,billable DOUBLE WALLED Continuous Inlematoo Monitoring
<br /> 2362 1 390005167360515557 PT0011472 20,000 REGULAR UNLEADED Active,billable DOUBLE WALLED Conllnuous Interstitial Monitoring
<br /> Underground Storage Tank Permit Conditions
<br /> 1) The Permit to Operate will become void if Annual Permit Fees and Service Fees are not paid andlor the UST system(s)fails to remain in compliance with these Permit Conditions.
<br /> 2) In order to maintain the operating permit,the owner and operator shall comply with the H&S Code,Div.20,Chap.6.7 and 6.75;and CCR,Title 23,Chap.16 and 18,as well as any conditions
<br /> established by San Joaquin County.
<br /> 3) If the Tank Operatri is different 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 ensure that both
<br /> the Tank Owner and tank Operator receive a copy of the permit.
<br /> 4) Written Monitoring Procedures and an Emergency Response Plan must be approved by the Environmental Health Department(EHD)and are considererd UST Pemut Conditions. The approved
<br /> monitoring,response,and plot plans shall be maintained onsite with the pemut.
<br /> 5) The Perminee shall comply with the monitoring procedures referenced in this permit.
<br /> 6) The Permittee shall perform testing and preventive maintenance on all leak detection monitoring equipment annually,or more frequently ifspecified by the equipment manufacturer,and
<br /> provide documentation of such servicing to this office.
<br /> 7) In the event of a spill,leak,or other unauthorized release,the Permit"shall comply with the requirements of Title 23 CCR,Chap.16,Art.5,and the approved Emergency Response Plan.
<br /> 8) Written records of all monitoring performed shall be maintained on-site by the operator and be available for inspection for a period of at least three years from the dale the monitoring was
<br /> performed.
<br /> 9) The 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 UST system(including change in tank contents or usage),the Permit to Operate will be subject to review,modi fteation or
<br /> 11) UlY61AiRibn,repair and/or removal permits are required from the 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 date of die issuance of this permit.
<br /> 13) This Permit to Operate shall not be considered permission to violate any laws,ordinances or statutes of any other Federal,Stale or Local agency.
<br /> 14) A"Conditional"Permit maybe revoked if corrections specified on the inspection report are not completed by the dale(s) indicated.
<br /> PERMITS TO OPERATE are NOT TRANSFERABLE
<br /> and may be SUSPENDED or REVOKED for cause.
<br /> PERMIT(s)Valid only for: DENNIS JACOBSEN FAMILY HOLDING
<br /> DBA: SAFEWAY STORE#1769
<br /> THIS FORM MIDST DE DISPLAYED CONSPICUOUSLY ON THE PREMISES
<br /> Regulated Facility SAFEWAY FUEL CENTER#1769 Facility ID FA0012764
<br /> 2808 COUNTRY CLUB BLVD Account ID AR0021335
<br /> STOCKTON, CA 95204 Issued 4/1/2004
<br /> Billing Address: ATTN : C/O DAIGNEAU, EMILY
<br /> SAFEWAY FUEL CENTER #1769
<br /> 12265 W BAYAUD AVE, STE 300
<br /> LAKEWOOD, CO 80228
<br /> 7023.rpt
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