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of SAN 30%UIN COUNTY PUBLIC HEALTH&VICES 304 E. WEBER AVE.,THIRD FLOOR, • STOCKTON,CA 95202 • PHONE (209)468-3420 KAREN FORST, M.D.,M.P.H., HEALTH OFFICER DONNA HERAN,R.E.H.S., DIRECTOR ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL CERTIFIED �UNIFIED HEALTH AGENCY SAN JOAQUIN COUNT PERMIT TO OPERATE Permit Program Permit Program Code and Description Valid Record ID Number 111101 To 12131101 PR0231482 2100—,UNDERGROUND STORAGE TANK FACILITY Underground Stpraae Tank Program: Chap. --- ----------- -- Califomia Health and Safety Code Diu.20,Cha 6.7 and Titre 23 California Code of Regulations Chap.___ __ _ ______�__ _ _ --- -------- -- - - ---- k# Tank Re - __-__- Permit Status System e PIE Tank# Tank Record ID Permit# Capacity Contents DOUBLE WALLED 2360 6 390002314820504846 PT0007198 2,632 DIESEL Active UNLEADED Active 'DOUBLE WALLED 2360 5 394002314820504845 PTOg07197 6,768 DOUBLE WALLED 2362 4 390002314820504844 PT0007196 2,632 UNLEADED Active Underground Storage Tank Permit Conditions 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 these Permit Conditions. 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. 16andI8,aswell as anyconditions established by San loaquinCounty. 3) If the Tank Operator(s)is different from the Tank Owner,or if the Permitto Operate is issued to a person other than the owner or operator of the tank,the Permittee shall ensure that both the Tank Owner and tank Operator receive a copy of the permit. Monitoring Procedures and an Emergency Response Plan must be approved by the Environmental Health Division(PHSIEHD)and are considererd UST Permit 4) Written Conditions. 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. 5) The Permittee shall comply with the monitoring procedures referrenced 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 servic ing 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 fora 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 an y change in equipment,design or operation of the UST system(including change in tank contents or usage),the Permit to Operate will be subjcct to 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 USC Permit Conditions within 30 days of the anniversary date of the issuance ofthis 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: MADSEN, ROBERT& CAROL DBA: MADSENS SUNRISE DAIRY THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES Facility ID FA0000720 SEN'S SUNRISE DAiRY Regulated Faciiif�r; �. Account ID AR0000719 239 S S ST_ .. Issued 3/2912001 RiPON. CA 95366 Billing Address: ATTN : MADSEN, ROBERT MADSEN'S SUNRISE DAIRY 239 S STOCKTON RIPON, CA 95366 7Oz3.rpt