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SAN JOA UIN COUNTY PUBLIC HEALTH OVICES _r 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 COUN PECE ITTo D uN1nEE PROGRAM AGENCY unt Valid erpro rm Codend Descriptio ogram RecordID Number 111100 To 12131100 PR023225 2300-UNDERGROUND STORAGE TANK FACILITY Underground Storage Tank Program: _ - - - - Cha 6.7 and Title- -California Code of Regulations Chap _ _-- -s em ype e e cion ------ --- --y� - -- - ----��- ermi us Y California Health and Safety Code Dlv.20, erm� - - - on alone 2360 6 390002322590225906 PT0004150 8,000 UNLEADED Conditional DOUBLE WALLED INTERSTITAL MONITOR BOE 1D#:.44-024994..,,•...., Underground Storage Tank Permit Conditions Div.20,Chap.6.7 and 6.75;and CCR,Title 23,Chap. 16 and I) The permit to Operate will become void if Arcual Permit Fees and Service Fees are not paid and/or the UST systems)fails to remain in compliance with these Permit Conditions. the permit holder shall comply with the H&S Code, 2) In order to maintain the operating�ermit, Sn log mCounty. operator of the tank,the 18,as well as any conditions esm fished by of the sued Permit,3) If the Tank 0 emtor(s)is different from the Tank Owner,or if the Permit to Operate is issued to a person other than the owner S and are considererd Permittee shall ensure that both the Tank Owner and tank Operator receive a copy (p UST Permit itoring prs. Copies ofthe Procedures and Emergency Response Plan must be attached to this permit or be available for review and/or inspection q) Written Monitoring.Proceduresenil an Emergency Res onse Plan must be ap oved by dee Environmental Health Division. HS/HHD th UST site. men[annually,or more it frequently if specified by the 5) �he$ermroee shall comply with the monit erVennvecmaintenance on allileak detection monitoring equip 6) The Permittee shall perform testing and pr equipment manufacturer,and provide documentation of such servicing this office.wi�the requirements of Title 23 CCR,Chap- or and e 7) In the event ofaspill,leak,or other unauthorized release,the Pennitee shall comply approved Emergency Response Plan. g) 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 ee year 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.),the 10) Upon any change in equipment,design or operation ofthe UST system(including change in tank contents or usage},the Permit to Operate will he subject 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 and%or[en annual report documenting compliance with the UST Permit Conditions within 30 days of the anniversary date of the issuance of this permit. indicated. 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. 1q) A This Permit may be revoked if corrections specified on the inspection report are not completed by the date(s) PERMITS TO OPERATE are NOT TRANSFERABLE and may be SUSPENDED or REVOKED for cause. PERMIT(S)Valid only for: LUKOSE,JOSEPH Tank Owner: PHILIP, MATHEWIJAMES THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES Facility ID FA0001457 COLLEGEVILLE MARKET&CAFE" Account ID AR0001456 Regulated Facility: Issued 912812000 13521 E MARIPOSA RD STOCKTON, CA 95205 Billing Address: P MATHEW COLLEGEVILI E MARKET&CAFE" 13521 E MARIPOSA RD • STOCKTON, CA#05 7023.rpt _