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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTAAET;1
<br /> 304 E.Weber Ave.,Third Floor• Stockton,CA 95202-2708•Phone(209)468-3420
<br /> -JJ�RDon aaHeran,RETH.SS..,�D�irector
<br /> SAN JA'tjU1N'(''OIPCMETFUIEITUNIF'IXTHM AGENCY
<br /> PERMIT TO OPERATE -
<br /> Prcgram Permit Permit
<br /> Record ID Number Program Code and Description
<br /> Valid
<br /> PR0518923 PT0012257 2220-SMALL QUANTITY HAZARDOUS WASTE GENERATOR FACILITY 1/1/2005 To 12/31/2000
<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_25100et s — e ,Califonia Regulations,Chap
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<br /> PH
<br /> _________
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<br /> PRySt 36 2300-UNDERGR ND STORAGE TANK FACILITY 1/112005 To 12/31/2005
<br /> Ur_{1S erground Storage Tank Program'
<br /> Car _ Health and Safet _ 0,Chap.6.7 and Title 23,California Code of Regulations,Chap:16__
<br /> _ __---- ---------- - . . ------. --..----_._.-- ..-.
<br /> P/E Tank# Tank Recor ID 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 REGULAR UNLEADED Active,billable DOUBLE WALLED continuous Intersinuai isenuor w
<br /> 2360 3 390005167360515559 PT0011474 10,000 REGULAR UNLEADED Active,billable DOUBLE WALLED continuous Interstitial Moniteona
<br /> 8CE ID#:144-040801_.. .. ,.,
<br /> Underground Storage Tank Permit Conditions
<br /> 1) The Permit to Operate will become void if Annual Permit Fees and ServiceFees are not paid and/or the UST systems)fails to remain incompliance 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 n 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 Perrninee shall ensure that both
<br /> the Tank Owner and lank 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 eonsidererd UST Permit Conditions. The approved
<br /> monitoring,response,and plot plans shall be maintained onsite with the permit.
<br /> 5) The Pernotme 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 mom frequently ifspecifted by the equipment manufacturer,and
<br /> provide documentation of such servicing to this office.
<br /> 7) In the event of 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) Whitten 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 /> t 1) Construction,repair and/or removal prints are required from the EHD prior to any change,repair or removal of UST system equipment.
<br /> 12) The Penniaee shall submit an annual report documenting compliance with the UST Permit Conditions within 30 days of the dale of the issuance of this Permit.
<br /> 13) '1 his 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 dam(s) indicated.
<br /> PERMITS TO OPERATE are NOT TRANSFERABLE
<br /> I and may be SUSPENDED or REVOKED for cause.
<br /> PERMIT(s)Valid only for: DENNIS JACOBSEN FAMILY HOLDING
<br /> DBA: SAFEWAY STORE#1769
<br /> r Tank Owner: SAFEWAY FUEL CENTER#1769
<br /> l THIS FORM MUST HE DISPLAYED CONSPICUOUSLY ON THE PREMISES
<br /> Regulated Facility: SAFEWAY FUEL CENTER#1769 FacilityID FA0012764
<br /> 2808 COUNTRY CLUB BLVD Account ID AR0021335
<br /> STOCKTON, CA 95204 Issued 2/10/2005
<br /> 8ilfng 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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