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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> 304 E.WEBER AVE.,THIRD FLOOR • STOCKTON,CA 95202 • PHONE (209) 468-3420 <br /> KAREN FURST,M.D., M.P.H., HEALTH OFFICER <br /> DONNA HERRN, R.E.H.S., DIRECTOR ENVIRONMENTAL HEALTH DIVISION <br /> ENVIRONMENTAL HEALTH <br /> SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY <br /> PERMIT TO OPERATE <br /> rogram ermrt Permit <br /> Record lD Number Program Code and Description Valid <br /> PR023184 2300-UNDERGROUND STORAGE TANK FACILITY 111100 To 12131100 <br /> Underground Storage Tank Program: <br /> California Health and Safety Code Div.20,Chap.6.7 and Title 23 California Code of Regulations Chap. 16. <br /> ImK0 I anK KCCOWermr apace y Lonmms Permit, a us Syslern I ype I.eaK Defccuon <br /> 2301) 1) 69000231849018490b PT0004634 7,500 01HEH Active UUUULL LIFT <br /> 2360 5 390002318490184905 PT0004633 1,000 UNLEADED Active DOUBLE WALLED AUTOMATIC TANK GLACE <br /> 2360 4 390002318490184904 PT0004632 6,000 OTHER Active DOUBLE WALLED AUTOMATIC TANK GUAGE <br /> BOE IDfl: 44-024901 <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 compliance with <br /> these Permit Conditions. <br /> 2) In order to maintain the operatingpermit,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 <br /> 18,as well as any conditions established by San Joaquin County. <br /> 3) If the Tank Operator(s)is different from the Tank Owner,or if the Pemtit to Operate is issued to a person other than the owner m operator of the tank,the <br /> Permittee shall ensure that 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 die Environmental Health Division(PHS/EHD)and are considererd <br /> UST Permit Condrtiew. Copies of the Procedures and Emergency Response Plan must be attached to this permit or be available for review and/or inspection <br /> �e UST site. <br /> 5) he Permittee shall comply with the monitoring procedures referrenced in this permit. <br /> 6) The Permittee shall perform testing and preventive maintenance on all leak detection monitoring equipment annually,or more frequently if specified by the <br /> equipment manufacturer, and provide documentation of such servicing to this office. <br /> 7) In the event of a spill,leak,or other unauthorized release,the Pemrilee shall comply wi th the requirements of Title 23 CCR Chap. 16,Art.5,and the <br /> 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 o fat least three years <br /> from the date the monitoring 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 UST system(including change in tank contents or usage),the Permit to Operate will be subject to <br /> review,modification or revocation. <br /> 11) Construction,repair and/or removal permits are required from the PHS/EI ID 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 <br /> 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 may be revoked if corrections 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: SJC MOSQUITO&VECTOR CTRL <br /> Tank Owner: SAN JOAQUIN CO MOSQUITO ABATEM <br /> THIS FORM MAST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: SJ CO MOSQUITO &VECTOR CTRL Facility to FA0003762 <br /> 200 N BECKMAN RD Account ID AR0003341 <br /> LODI, CA 95240 Issued 10/10/2000 <br /> Billing Address: ATTN : SAN JOAQUIN CO MOSQUITO ABATEM <br /> SJ CO MOSQUITO&VECTOR CTRL <br /> 7759 S AIRPORT WY <br /> STOCKTON, CA 95206 <br /> 7023 pt <br />