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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES 304 E.WEBER AVE.,THIRD FLOOR • STOCKTON,CA 95202 • PHONE (209)468-3420 KAREN FORST, M.D., M.P.H., HEALTH OFFICER DONNA HERRN, R.E.H.S., DIRECTOR ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY PERMIT TO OPERATE _ ernut RgdlDeco Number Program Code and Description Valid PR023151 2300-UNDERGROUND STORAGE TANK FACILITY 111100 To 12131100 Underground Storage Tank Program: California Health and Safety Code Div.20,Chap.6.7 and Title 23 California Code of Regulations Chap. 16. - - - - -- - - - -- - - -- - - - - --- an ecor i Capacity ens remit brains NyslemYP Active DOUBLE WALLED 2360 1 390002315170151701 PT0004112 1,000 OTHER Active DOUBLE WALLED BOE ID#:.44-024731 - Underground Storage Tank Permit Conditions I The Permit to Operate will become void if Annual Perm it Fees and Service Fees are not paid and/or the UST system(s)fails to remain in compliance with these Permit Conditions. 2) In orderto maintain the operatingpermit,the permit Folder shall comply with the H&S Code,Div.20,Chap.6.7 and 6.75;and CCR,Tide23,Chap. 16 and 18,as well as any conditions established by San Joaquin County. 3) Ifthe 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 operatorof the tank,the Permittee shall ensure that both the Tank Owner and tank Operator receive a copy of the permit. 4) Written Monitoring Procedures and an Emergency Re onse Plan must be approved by the Environmental Health Division(PHS/EHD)and are considererd USTPemiit Conditions. Copies of the Procedures andergency Response Plan most be attached to this permit orbe available for review and/or inspection at AT site. 5) I tie�ennittee 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 Permitee shall comply with the requirements of Title 23 CCR Chap. 16,Art.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 PHS/EHD shall be notified of any change in ownership or operation of the UST system within 30 days of such change. 10) Upon any changein equipment,design or operation of the UST system(including change in tank contents or usage),the Permit to Operate will be subjectto review,modification or revocation. 11) Construction,repair and/or removal permits are required from the PHS/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 the 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. j PERMITS TO OPERATE are NOT TRANSFERABLE and may be SUSPENDED or REVOKED for cause. PERMIT(s)Valid only for: CHEROKEE MEMORIAL PARK INC DBA: CHEROKEE MEMORIAL PARK THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES Facility ID FA0003689 Regulated Facility: CHEROKEE MEMORIAL PARK Account to AR0003267 13823 N BECKMAN RD Issued 9/28/2000 LODI, CA 95240 Billing Address: ATTN : CHEROKEE MEMORIAL PARK CHEROKEE MEMORIAL PARK PO BOX 1000 D LODI, CA 95240 7023.rpt