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L SAN JOA*IN COUNTY PUBLIC HEALTH S9VICES 304 E.WEBER AVE.,THIRD FLOOR • STOCKTON.CA 95202 • PHONE (209) 468-3420 KAREN 'DURST, M.D., M.P.H., HEALTH OFFICER DONNA HERAN,R.E.H.S., DIRECTOR ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY PERMIT TO OPERATE ermit rogramermtt Program Code and Description Valid Record ID Number g 111100 T712131/00 71I 2300-'UNDERGROUND STORAGE TANK FACILITY Underground Storage Tank Program: California Health and Safety Code Div.20,Chap.6.7 and T -itle 23 California Code of Regulations Chap. 16. _ _ - - _ - _ - - _ _ - ` -s em e eran - -- -apacr y on en ermr a us y �1111 111111111l11 12160 '6 -390002314820504846 I"I 1 111 1111, 1,1 11 771--- G Ive UNLEADED Active DOUBLE WALLED 2360 5 390002314820504845 PT0007197 6,768 DOUBLE WALLED 2360 4 390002314820504844 PT0007196 2,632 UNLEADED Active Underground Storage Tank Permit Conditions I) 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 orderto maintain the operating permit,the permit holder shall comply with the H&S Code,Div.20,Chap.6.7 and 6.75;and CCR Tide 23,Chap. l6 and 18,as well as any conditions established by San Joaquin County, 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 both the Tank Owner and tank Operator receive a copy of the permit. 4) Written Monitoring Procedures and an Emergency Response Plan must be appproved by the Environmental Health Division(PHS/EHD)and are considererd UST Permit Conditions. Copies of the Procedures and Emergency Response must be attached to this permit or be available forreview and/or inspection th UST site. 5) ' e�ertmttee shall comply with the monitoring procedures referrenced in this permit. 6) The Permittee shall perform testing and preventive maintenance on all leakdetection 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 spill,leak,or other unauthorized release,the Permitee shall comply with the requirements of Title 23 CCR, Chap. l6,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 change in 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. 1 l) Construction,repair and/or removal permits are required from the PHS/EH D 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. r 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 h1UST BE DISPLAYED CONSPICt.IQUSLY ON THE PREMISES MADSf=N'S SUNRISE DAIRY Facility ID FA00007z0 Regulated Facility: Account ID AR0000719 239 S STOCKTON ST Issued 9/2812000 RIPON, CA 95366 Billing Address: ATTN : MADSEN, ROBERT MADSEN'S SUNRISE DAIRY 239 S STOCKTON RIPON, CA 95366 7023.rpt