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<br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 304 E-Weber Ave.,Third Floor•Stockton,CA 95202-2708• Phone(209)466-3420 �
<br /> Donna Heran,RE.H.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 Program Code and Description - - Valid
<br /> PRO518923 PT00122572220-SMALL QUANTITY HAZARDOUS WASTE GENERATOR FACILITY 1/1/2007 To 12/3112007
<br /> Hazardous Waste Generator Program:
<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 at sect,and Title alifornia Code of Regulations,Chap.20-------------------------------- ------ ------ ----- --------- --------
<br /> PR0516736 2300 UNDERGROUND STORAGE TANK FACILITY - 111/2007 To 12/31/2007.
<br /> Underground Stora e 7 nk Pro ram
<br /> California Health and S ty Code,D v.20,Chap.6.7 and Title 23,California Code of Regulations,Chap_ 16,
<br /> ----- --------- -- --------- ------------ --- ---...........................................-------
<br /> P/E Tank# Tank Record W Permit 4 Capacity Contents Permit Status System Type- Leak Detecllon
<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 /> Underground Storage Tank PermitConditions
<br /> 1) The Permit to Operate will become void if Annual Permit Fees and Service Fees are not paid and/or theUST 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 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 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 Pennines 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. : 1
<br /> 7j in the event of a spill,leak,or other unauthorized release;the Permitee 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 of the 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) Construction,repair and/or removal permits are requiredfrom 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,Some or Local agency.
<br /> 14) A"Conditional"Permit may be 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 /> 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 to AR0021335
<br /> STOCKTON CA 95204 Issued 3/26/2007
<br /> Billing Address: 'ATTN : ATTNi 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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