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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E-Weber Ave.,Third Floor•Stockton,CA 95202-2708• Phone(209)4683420 Donna Henn,REH.S.,Director ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY PERMIT TO OPERATE Program permit Record ID Number Program Code and Description Permit PR051673 2300-UNDERGROUND STORAGE TANK FACILITY Valid 1/1/2002 To 12(31/2002 Um nderound Storage Tank Program, California Health and Safe Code Dlv.20,Chap,6.7 and Title 23 California Code of Regulations Chap_16. _ ra ---H -- - --------- - ----- P/E Tank# 'ran Tank Record ID Permit# Ca aci __. P onlents Permit Status System Type 2360 3 390005167360515559 PT0011474 10,000 REGULAR UNLEADED Active,billable DOUBLE WALLED congruous Interstitial 2360 2 390005167360515558 PT0011473 10,000 REGULAR UNLEADED Monitoring rinim g Active,billable DOUBLE WALLED Continuoultal 2362 1 390005167360515557 PT0011472 20,000 REGULAR UNLEADED MosInng Active,billable DOUBLE WALLED Continuouus ring tial Underground Storage Tank Permit Conditions Monitoring 7) The Permit to 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(hese Permit Conditions. 2) In order to maintain the operating pemnl,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 established by San Joaquin Comity. 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 Pemmittee shall ensure that both the Tank Owner and tank Operator receive a copy of the permit. 4) Wdl(en Monitoring Procedures and an Emergency Response Plan must be approved by the Environmental Health Department(EHD)and are considererd UST Pemd1 Conditions. The approved monitoring,response,and plot plans shall be maintained onsite with the permit. 5) The Pemotme shall comply with the monitoring procedures referenced in this permit. 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 provide documentation of such servicing to this office. 7) In the event of a spill,leak,or other unauthorized release,the Permime shall comply with the requirements of Title 23 CCR Chap.16,An.5,and the approved Emergency Response Plan. 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 performed. 9) The EHD shall be rmtified of any change in ownership or operation of the UST system within 30 days of such change. 10) Upon any change in equipment,design or operation of UST system(including change in tank contents or usage),the Permit to Operate will be subject to review,modification or revocation. 11) Construction,repair and/or removal pemmits are required from the EHD prior to any change,repair or removal of UST system equipment. 12) The Permittee shall submit an annual report documenting compliance with the UST Permit Conditions within 30 days of the anniversary date of(he issuance of this permit. 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. 14) A"Conditional"Permit may be revoked if corrections specified on the inspection report are not completed by the date(s) indicated. PERMITS TO OPERATE are NOT TRANSFERABLE and may be SUSPENDED or REVOKED for cause. PERMIT(s)Valid only for: DENNIS JACOBSEN FAMILY HOLDING 1'l1 IS F'0 RM MAST RE DISPLAYED CONSPICUOUSLY ON THE PREMIS&S Regulated Facility: SAFEWAY FUEL CENTER#1769 Facility ID FA0012764 2808 COUNTRY CLUB BLVD Account lD AR0021335 STOCKTON. CA 95204 Issued 5/6/2002 Billing Address: ATTN : SAFEWAY, INC SAFEWAY FUEL CENTER#1769 PO BOX 29096 PHOENIX, AZ 85038-9096 7023.rpt