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SAN JOAQUIN COUNTY ENVIRONT�%JENTAL HEALTH DEPARTMENT
<br /> 304 E.Weber Ave.,Third Floor•Smdcmn,CA 95202-2708 • Phone(209)468-3420
<br /> Donna Heran,REH.S.,Director
<br /> ENVIRONMENTAL HEALTH
<br /> SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY
<br /> PERMIT TO OPERATE
<br /> Permit
<br /> Program Permit Valid
<br /> Record ID Number Program Code and Description
<br /> PR0518923 PT0012257 2220-SMALL QUANTITY HAZARDOUS WASTE GENERATOR FACILITY 1/1/2004 To 12/3112004
<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 seq,-and Title 22,Califomia Code of Regulations,Chap_20................... ............_---_-------___.
<br /> -------- ---------------------------------------------
<br /> PR0516736 2300-UNDERGROUND STORAGE TANK FACILITY 1/1/2004 To 1213112004
<br /> Underground Storage Tank Program:
<br /> Califomia Health and Safety Code:Div_20:Chap.6,7 and Title 23,California Code of Regulations,Chap,16: ------___----_----------____..__._------__
<br /> -71 PIE Tank# Tank Record ID Permit# Capacity Con:ents Permit Status System T,,?e Leak Detection
<br /> 2360 3 390005167360515559 PT0011474 10,000 REGULAR UNLEADED Active,billable DOUBLE WA%U EO continuous Interstitial Monitonng
<br /> 2360 2 390005167360515558 PT0011473 10,000 REGULAR UNLEADED Active,billable DOUBLE WALLED continuous Interstitial Monitanng
<br /> 2362 1 390005167360515557 PT0011472 20,000 REGULAR UNLEADED Active,billable DOUBLE WALLED Continuous Interstitial Monitoring
<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 complia,r-with these Permit Conditions.
<br /> 2) In order to maintain the operating permit,the owner and operator shall comply with the H&S Cede.Div.20,Chap.6.7 and 6.75;and CCR,Title 23,Chaff. 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 isssd to a person other than the owner or operator of the_:c.the Permittee shall ensure that both
<br /> the Tank Owner and tank Operator receive a copy of the permit.
<br /> 4) W riven Monitoring Procedures and an Emergency Response PW most be approved by the Em ro ental Health Department(EHD)and are considererd UST Pernat Conditions. The approved
<br /> monitoring,response,and plot plans shall be maintained onsite with the pemdt
<br /> 5) The Permittee shall comply with the monitoring procedures mferenced in this permit-
<br /> 6)
<br /> ermit6) The Permittee shall perform testing and preventive maintenance on all leak detection monimring equipment annually,or more frequently if speci5ed 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 Pennitee shall comply with ee requirements of Title 23 CCR Chap.16,Art.5,and dw 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 thmr.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 /> 11) Cd'i&W&tgIbn,repair and/or removal pewits arc required from the EHD prior to any change,mart or removal of UST system equipmlem.
<br /> 12) The Permittee shall submit an annual report documenting compliance with the UST Peorut CotsYtions within 30 days of the date of the issuance of this pemnit
<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 ifcoummms 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 /> THIS FORM JUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES
<br /> Regulated Facility SAFEWAY FUEL CENTER#1769 Faality ID FA0012764
<br /> 2808 COUNTRY CLUB BLVD A`x0i'nt ID AR0021335
<br /> STOCKTON, CA 95204 L--ed 4/1/2004
<br /> Billing Address: ATTN : C/O DAIGNEAU, EMILY
<br /> SAFEWAY FUEL CENTER #1769
<br /> 12265 W BAYAUD AVE, STE 300
<br /> LAKEWOOD, CO 80226
<br /> 7023.rpt
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