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SAN JOAQUICOUNTY ENVIRONMENTAL HEALTIIDEPARTMENT
<br /> 304 E.Weber Ave.,Third Floor• Stockton,CA 95202-2708• Phone(209)468-3420
<br /> Donna Heran, R.E.H.S.,Director
<br /> ENVIRONMENTAL HEALTH
<br /> SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY
<br /> PERMIT TO OPERATE
<br /> Permit Permit
<br /> Record ID Num Program Code and Description
<br /> Valid
<br /> PR0518923 PT00122 2220-SMALL QUANTITY HAZARDOUS WASTE GENERATOR FACILITY 1/112003 To 12/3112003
<br /> FRF
<br /> rdo s a le a al r Pro ram:
<br /> California H and Safety Code,Div.20,Chap.6.5,Art.2-13,Sec 25100 et seq,and Title 22,California Code of Regulations,Chap.20.
<br /> PRO516736 2300-UNDERGROUND STORAGE TANK FACILITY 111/2003 To 12131/2003
<br /> Underground Storage Tank Program:
<br /> California Health and Safety Code,Div_20,Chap.6.7 and Title 23,Califomia Code of Regulations,Chap_16.
<br /> P/E Tank# Tank Record ID Permit# Capacity Contents 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 Interstitial Monitoring
<br /> 2362 1 390005167360515557 PT0011472 20,000 REGULAR UNLEADED Active,billable DOUBLE WALLED Continuous Interstitial Monitoring
<br /> Underground Storage Tank Permit Conditions
<br /> I) The Permit to Operate will become void if Annual Permit Fees and Service Fees are not paid and/or the UST system(s)fails to remain in compliance with these Permit Conditions.
<br /> 2) In order to maintain the operating permit,00 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 Operator(s)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 lank,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 most be approved by the Envimnniental Health Department(EHD)and are consider ad UST Permit Conditions. Tim approved
<br /> monitoring,response,and plot plans shall be maintained onsite with the permit.
<br /> 5) The Permittee 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 if specified by the equipment manufacturer,and
<br /> provide documentation of such servicing to this office.
<br /> 7) In the event of spill,leak,or other unauthorized release,the Pemnitee shall comply with the requirements of Title 23 CCR,Chap.16,An.5,and the approved Emergency Response Plan.
<br /> 8) Written records of all monitoring perfomned shall be maintained on-site by the operator and be available for inspection for a period of at least three years from the date 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,modification or
<br /> 11) MYRE Rlbn,repair and/or renwval 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 anniversary date of the 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,Slate or Local agency.
<br /> 14) A"Conditional"Permit maybe revoked ifcorrections specified on the inspection report are not completed by the dale(s) indicated.
<br /> PERMTTS 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 MAST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES
<br /> RegulatedFacilily: SAFEWAY FUEL CENTER#1769 FacilitylD FA0012764
<br /> 2808 COUNTRY CLUB BLVD Account ID AR0021335
<br /> STOCKTON, CA 95204 Issued 8/19/2003
<br /> Billing Address: ATTN : MS #6516 TAX, NASC
<br /> SAFEWAY FUEL CENTER #1769
<br /> PO BOX 29096
<br /> PHOENIX, AZ 85038-9096
<br /> 7023.rp1
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