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SAN JOAaUIN COUNTY PUBLIC HEALTH S&VICES <br /> 304 E. WEBER AVE.,THIRD FLOOR a STOCKTON,CA 95202 a PHONE(209) 468-3420 <br /> KAREN FURST, M.D., M.P.H., HEALTH OFFICER <br /> DONNAHERA , R.E.H..S., DIRECTOR ENVIRONMENTAL HEALTHDIVISION <br /> E4NQUN, H.YIR� ♦ <br /> SAN0DTAOAHNCY <br /> PERMIT TO OPERATE <br /> Program Permit Permit <br /> Record ID Number Program Code and Description Valid <br /> PRO51673 2300-UNDERGROUND STORAGE TANK FACILITY 9/19/01 To 12/31/01 <br /> Underground Storage Tank Program, <br /> California Health and Safety Code Div.20,Chap.6.7 and Title 23 California Code of Regulations Cha__16,_ __ _ <br /> - - --- - ---- - - - - - - - - - --- -- - P- --- - - -- - -- -------- - --p - - - - — - - - - - - -PIE Tank Tank# Tank Record ID Permit# Capacity Contents Permit Status System Type <br /> 2360 3 390005167360515559 PT0011474 10,000 REGULAR UNLEADED Active,billable DOUBLE WALLED <br /> 2360 2 390005167360515558 PT0011473 10,000 REGULAR UNLEADED Active,billable DOUBLE WALLED <br /> 2362 1 390005167360515557 PT0011472 20,000 REGULAR UNLEADED Active,billable DOUBLE WALLED <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 IM UST system(s)fails to remain in compliance with these Permit Conditions. <br /> 2) In order to maintain the operating permit,the permit holder 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 <br /> conditions established by San Joaquin County. <br /> 3) If the Tank Operators)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 <br /> both 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 Division(PHS/EHD)and are considererd UST Permit Conditions. <br /> Copies of the Procedures and Emergency Response Plan must be attached to this permit or be available for review and/or inspection at the UST site. <br /> 5) The Permittee shall comply with the monitoring procedures mferenced in this permit. <br /> 6) The renounce shall perform testing and preventive maintenance on all leak detection monitoring equipment annually,or more frequently if specified by the equipment manufacturer, <br /> and provide documentation of such servicing to this once. <br /> 7) 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 <br /> 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 <br /> was performed. <br /> 9) The PHS/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 /> I) Construction,repair and/or removal permits are required from the PHS/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 anniversary 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 maybe revoked if corrections specified on the inspection report are not completed by the dates) 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 /> 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 ID AR0021335 <br /> STOCKTON. CA 95204 Issued 9/19/2001 <br /> Billing Address: ATTN : SAFEWAY, INC <br /> SAFEWAY FUEL CENTER#1769 <br /> 5918 STONERIDGE MALL RD <br /> PLEASANTON, CA 94588 <br /> 7023.rpt `d <br />