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<br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 3041-Weber Ave.,Third Floor•Srodmon,CA 95202-2708• Phone(209)468-3420
<br /> Dona Haan,R.EH.S-,Director
<br /> ENVIRONMENTAL HEALTH
<br /> SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY.
<br /> PERMIT TO OPERATE
<br /> Program Permit - Permit
<br /> Record ID Number Aogram ode and Description
<br /> Valid
<br /> PROSIB923 PT00122512220-PMALL QUANTITY HAZARDOUS WASTE GENERATOR FACILITY 1/1/2007 To 12/31/2007
<br /> Hazardous Waste Generator Pro ra
<br /> In:order to maintain the rmit to crate, Hazardous Waste Generators shall comply with California Health and Safety Code,-Div.20,Chap.6.5;Art.2-13,
<br /> Sec.25100 etseq,and Title ,California Code_of Regulations,Chap_20,__
<br /> PRO516736 2300-UNDERGROUND STORAGE TANK FACILITY 1/1/2007 To.12/3112007.
<br /> Underground Storage Tank Program:
<br /> California Health and Safety Code Div.20,Cha------------------------------------------------------------6:7 and Title 23,California Code of Reulations,Chap.16,
<br /> ---- ------- ---- -- — ------- ------ ' -----
<br /> P/E Tank# Tank Record ID Permit# :Capacity "Contents Per-mit 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 REGULAR UNLEADED .Active,billable DOUBLE WALLED Continuous Interstitial Monitoring
<br /> 2360 3 390005167360515559 PT0011474 10,000 REGULAR UNLEADED ,Active,billable DOUBLE WALLED Continuous Interstitial Monitoring
<br /> . `OIDBi -
<br /> Underground Storage.Tank Permit Conditions"
<br /> 1) The Permit w Operate will become void if Annual Permit Fees and Service Fees are not paid and/or the UST systems)fails to remain in compliance with these Permit Conditions.
<br /> 2) In order to maintain the operating permit,theownerand 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) Ifthe Tank Operator(s)is ditferent,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 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 famines 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 /> 7j In the event of spill,leak,or other unauthorized release;the Pemtitee 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 EHD shall be notified of any change in ownership or operation of1he UST system within 30 days of such.change.
<br /> 10) Upon any changein 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) Concoction,repair and/or removal permits we required,from the EHD prior to any change,repair or removal of UST system equipment.
<br /> 12) The Pemnuee 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 my taws,.ordinances or statutes of any other Federal,State or Local agency.
<br /> 14) A"Conditional"Pemut maybe revoked if corrections specified on the inspectionreport 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 FUEL CENTER#1769
<br /> Tfil$FORM MUST 8E DISPLAYED CONSPICUOUSLY ON THE PREMISES
<br /> Regulated Facility: SAFEWAY FUEL CENTER#1769 Facilityto FA0012764
<br /> 2808 COUNTRY CLUB BLVD Account ID AR0021335
<br /> STOCKTON CA 95204 Issued.3/26/2007
<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 /> 7o25:rpt
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