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SAN JOAQUICOUNTY ENVIRONMENTAL HEALTHDEPARTMENT
<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 ambit Permit
<br /> Record ID Number Prog Code and Description Valid
<br /> PRO518923 PT0012257 2220)-SMALL QUANTITY HAZARDOUS WASTE GENERATOR FACILITY 1/1/2009 To 12/31/2009
<br /> Hazardous Waste Generator Pr ram:
<br /> In order to main am a permit to operate, Hazardous Waste Generators shall comply with California Health and Safety Code, Div.20,Chap.6.5,Art.2-13,
<br /> Sect 25100 et seq,_ancl Title 22,California Code of Regulations,Chap,20___ _
<br /> PRO516736 2300-UNDERGROUND STORAGE TANK FACILITY 1/1/2009 To 12/31/2009
<br /> Underground Storage Tank Program,
<br /> California Health and Safety Code,Div.20,Chap.6.7 and Title 23,California Code of Regulations,Chap_ 16.
<br /> __. ______ ____ _. _ __._.___ ____- ..------------------ .______-
<br /> P/E Tank Tank Record ID Permit# CapacityContents Permit Status System Type Leak Detection
<br /> 2362 1 390005167360515557 PT0011472 20,000 REGULAR UNLEADED Active,billable DOUBLE WALLED Continuous Intarstitial 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
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<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,die owner and operator shall comply with the H&S Code,Div.20,Chap.6.7 and 6.75;and CCR,Tide 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 rank,the Permince 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 Environmental Health Department(EHD)and ere considererd UST Permit Conditions. The 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 a spill,leak,or other unauthorized release,the Penri tee shall comply with the requirements of Title 23 CCA,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 my 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 /> I l) Construction,repair and/or removal pemdts 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 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,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 /> 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* Facility ID FA0012764
<br /> 2808 COUNTRY CLUB BLVD Account ID AR0021335
<br /> STOCKTON CA 95204 Issued 2/4/2009
<br /> Billing Address: ATTN : ATTN: MS #6516 TAX F-76
<br /> SAFEWAY FUEL CENTER #1769*
<br /> PO BOX 29096
<br /> PHOENIX AZ 85038-9096
<br /> 7023.rpt
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