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—F SAN JOAIN COUNTY PUBLIC HEALTH *ICES 304 E.WEBER AVE.,THIRD FLOOR • STOCKTON,CA 95202 • PHONE(209)468-3420 KAREN FURST,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 Penna Program rt Program Code and Description Valid Record ID 111/01 To 12131/01 PRO231458 NDERGROUND STORAGE TANK FACILITY oder round Storarte Tank Pr California Health and Safe Code Div.20,Cha .6.7 and Title:3 Califomia Code of Re ulations Chap:16__ _________________ __ _ ------ p Leak Detection P/E Tank# Tank Record ID Permit# Capacity Contents Permit Status System Type DOUBLE WALLED TANKTESTING 2360 5 390002314580508099 P70009524 6,000 PREMIUM UNLEADED Active DOUBLEWALLED TANKTESTING 2362 4 390002314580508098 PT0009523 9,000 REGULARUNLEADED Active Underground Storage Tank Permit Conditions 1) The pantit to Operate win become void if Annual Permit Fees and Service Fees are not paid and/orthe 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. 16 and 18,as wen as any conditions established by San Joaquin County. 3) If the Tank Opemtor(s)is different fmm the Tank Owner,or if the Permit to Operate is issued to a person other than the owner or operator of the tank,the Permitteeshall ensure that both the Tank Owner and tank Operaw receive a copy of the permit. 4) Written Monitoring Procedures and an Emergency Response Plan must beapprovedbylhe Environmental Health Division(PHS/EHD)andare considererd USTPermit Conditions. Copies of the Procedures and Emergency Response Plan most be attached to this pernit or be available for review and/or inspection at the UST site. 5) The Perm.ittee 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 ofsuch servicing to this office. 7) in the event of a spill, leak,or other unauthorized release,the Permike 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 change in equipment,design or operation ofthe USC system(including change in tank contents or usage),the Per mift to Operate will be subject to review, modification or rev=tion. 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 USr Permit Conditions wihin 30 days of rhe anniversary date ofthe 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. PERMITS TO OPERATE are NOT TRANSFERABLE and may be SUSPENDED or REVOKED for cause. PERMIT(s)Valid only for: ELDER, FASSEL M DBA: RAINWATER MINI MARKET Tank Owner: ELDER, PHIL THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES Facility ID FA0001196 Regulated Facility: RAINWATER MINI MARKET Account ID AR0001195 420 W YOSEMVFt AVE Issued 312912001 MANTECA. CA 95336 Billing Address: ATTN : RAINWATER MINIMARKET RAINWATER MINI MARKET 420 W YOSEMITE AVE MANTECA, CA 95336 7023.rpt 0 0