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SAN JOAQUIlVPOUNTY ENVIRONMENTAL HEALTOEPARTMENT
<br /> 600 E. Main St. • Stockton,CA 95202-3029 • 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 epnn _ - Perot
<br /> Record ID- Number .Code and Description Valid
<br /> PRO518923 PT0012257 2220-SMALL QUANTITY HAZARDOUS WASTE GENERATOR FACILITY 1/1/2012 To 12/31/2012
<br /> Hazardous Waste..Q2nam:
<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---- ----- -- _ _
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<br /> PR0516736 2300-UNDERGROUND STORAGE TANK FACILITY 1/1/2012 To 12/3112012
<br /> Underground Storage Tank Program:
<br /> California Health and Safety Code,Diva 20,Chap.6,7 and Title 23,California Code of Regulations,Chap: 16.; -
<br /> -._ ._.. _.-. ..__..------ .-... -.-...-- .. ....--. __.._ ........
<br /> P/E Tank# TankRecordID Permit# Capacity Contents Permit Status System Type Leak Detection
<br /> 2362 1 390005167360515557 PT0011472 20,000 . REGULAR UNLEADED Active,billable DOUBLE WALLED continuous Interstitial Monitoring
<br /> 2360 2 390005167360515558 PT0011473 10,000 PREMIUM UNLEADED Active, billable DOUBLE WALLED continuous Interstitial Monitoring
<br /> 2360 3 390005167360515559 PT0011474 10,000. MIDGRADE UNLEADED Active,billable DOUBLE WALLED Continuous 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 and/or the UST system(s)fails to remain in compliance with these Permit Conditions.
<br /> 2) In order to maintain die operating permit,die 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 an 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 mid an Emergency Response Plan most 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 Penruttee shall comply with the monitoring procedures referenced in this permit. -
<br /> 6) The Penninee 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 even[of a spill,leak,or other unauthorized release,the Permitee 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 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 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 /> revocation.
<br /> 11) Construction,repair and/or removal pennons 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"Permit may be revoked if corrections specified on the inspection report are not completed by the date(s) indicated.
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<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 /> Regulated Facility: SAFEWAY FUEL CENTER#1769' Facifity ID FA0012764
<br /> 2808 COUNTRY CLUB BLVD Account ID AR0021335
<br /> STOCKTON CA 95204 Issued Y110/2012
<br /> Billing Address: ATTN ATTN: MS #6516 TAX F-76
<br /> SAFEWAY FUEL CENTER #17.69* -
<br /> POBOX .29096 -
<br /> PHOENIX AZ "85038-9096 -
<br /> 702arpt
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