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SAN JOAQuIN COUNTY ENVIRONMENTAL .s
<br /> HEALTH DEPARTMENT
<br /> 304 E.Weber Ave.,Third Floor•Stodaton,CA 95202-2708• Phone(209)468-3420
<br /> Donna Heran,R-F-H.S.,Director
<br /> ENVIRONMENTAL HEALTH
<br /> SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY
<br /> Program Permit PERMIT TO OPERATE
<br /> Record ID Number Program Code and Description Permit
<br /> PR0518923 PT0072257 2220-SMALL QUANTITY HAZARDOUS WASTE GENERATOR FACILITY valid
<br /> Hazardous Waste Generator Program. .1/1/2006 To 12/31/2006
<br /> In order to maintain the permitto operate, Hazardous Waste Generators shall comply with California Health and Safety Code;Div.20,Chap.fi.5,Art.2-13,
<br /> Sec,25100 et seq,and Title 22,California Code of Regulations,Chap._20_ __
<br /> ---- - ---
<br /> PR0516736 -'---" --------
<br /> 2300-UNDERGROUND STORAGE TANK FACILITY
<br /> Underground Storage Tank Procram� 1/1/2006 To 12/3112006
<br /> California Health and Safety Code, Div 20,Chap.6.7 and Title 23,_California Code of Regulations,Chap, 16.
<br /> P/E Tank N Tank Record ID --.---------------------------------------------------------
<br /> --- ---------
<br /> ermt[A Capacity Contents Pemlit Status System Type Leak Detection
<br /> 2362 1 390005167360515557 V I UU11472 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,billableDOUBLE WALLED Continuous Interstitial Monilonig
<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,Tide 23,Chap.16 and 18,as well n any conditions
<br /> established by San Joaquin County. .
<br /> 3) If the Tank Opermor(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 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 theevent of a spill,leak,or other unauthorized release;the Perrnitce 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 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 pemnta 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 FUEL CENTER#1769
<br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON.THE PREMISES
<br /> Regulated Facility. SAFEWAY FUEL CENTER#1769 Fadlity ID FA0012764
<br /> 2808 COUNTRY CLUB BLVD Account ID AR0021335
<br /> STOCKTON CA 95204 Issued 2/3/2006
<br /> Billing Address: ATTN : C/O DAIGNEAU, EMILY
<br /> SAFEWAY FUEL CENTER #1769
<br /> 12265 W BAYAUD AVE, .STE 300
<br /> LAKEWOOD CO 80228
<br /> 7023.rpt
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