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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 1868 E.Hazelton Ave. • Stockton, CA 95205-6232 • 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 /> Program Permit Permit
<br /> Record to Number P gra Code and Description Valid
<br /> --PR0518923 PT00122F 22 -_ - tlS-WASTEGENERATOR FAC-ItlTY ---- --X043-Fo�2F311-2043— ---
<br /> Hazardous Waste Generatr Pro m:
<br /> In order to maintain the pe o operate,Hazardous Waste Generators shall comply with California Health and Safety Code,Div.20,Chap.6.5,Art.2-13,
<br /> Sec.25100 et seg and Title 22,California Code of Regulations,Chap.20, _----- ---------------- --- -----_-------------------------------__-_--------
<br /> PRO516736 2300-UNDERGROUND STORAGE TANK FACILITY 1/112013 To 1213112013
<br /> Underground Storage Tank Program:
<br /> California Health and Safety Code, Div.20,Chap.6.7 and Title 23,California Cooled e Regulations,Chap,16, _ -_......................................
<br /> ------------------------ ----------' — — —
<br /> ----- --- --- ----------------'Pi Tank Tank Tank Record ID Permit# Capacity Contents Permit Status System Type Leak Detection
<br /> 2362 1 390005167360515557 PT0011472 20,000 REGULAR UNLEADED Active,billable DOUBLE-WALL Continuous interstitial Monitoring
<br /> 2360 2 390005167360515556 PT0011473 10,000 PREMIUM UNLEADED Active,billable DOUBLE-WALL Continuous Interstitial Monitoring
<br /> 2360 3 390005167360515559 PT0011474 10,000 MIDGRADE UNLEADED Active,blllable DOUBLE-WALL Continuous Interstitial Monitoring
<br /> BOE ID#: 44040801
<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 and/or 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 Operators)is different from the Tank Owner,or iflhe Permit ro 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 Permit Conditions. The approved
<br /> monitoring,response,and plot plans shall be maintained onsite with the permit.
<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 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 Permitce 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 date the monitoring was
<br /> performed.
<br /> 9) The EIDJ 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 /> revocation.
<br /> 11) Construction,repair and/or removal permits are required from the EHD prior to any change,repair or removal of UST system equipment.
<br /> 12) 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 /> 13) A"Conditional'Perri may be revoked if corrections specified on the inspection report are not completed by the dates) indicated.
<br /> PERMITS TO OPERATE may be SUSPENDED or REVOKED for cause.
<br /> PERMIT(s) Valid only for: DENNIS JACOBSEN FAMILY HOLDING
<br /> DBA: SAFEWAY STORE#1769
<br /> Tank Owner: SAFEWAY INC
<br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES
<br /> SAFEWAY FUEL CENTER#1769* Facility ID FA0012764
<br /> Regulated Facility: Account ID
<br /> 2808 COUNTRY CLUB BLVD AR0021335
<br /> STOCKTON CA 95204 Issued 2119/2013
<br /> Billing Address: ATTN : ATTN: MS #6516 TAX F—' 6
<br /> SAFEWAY FUEL CENTER #1769* -
<br /> PO BOX 29096
<br /> PHOENIX AZ 85038-9096
<br /> 7023.rpt
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