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` SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E.Weber Ave.,Third Floor• Stockton,CA 95202-2708•Phone(209)468-3420 Donna Heran,REH.S.,Director ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY PERMIT TO OPERATE Permit Program Permit Valid Record ID Number Program Code and Description PR0232259 2300-UNDERGROUND STORAGE TANK FACILITY 11112003 To 12131/2003 Underground Storage Tank Program: - Califo_mia Health and Safety Code,Div_20.Chap.6.7 and Title 23,California Code of Regulations,Chap_16_ .-.--_-_-___-_--_--__---__--.-._---__-----_.. P/E Tank# Tank Record ID Permit# Capacity Contents Permit Status System Type Leak Detection PREMIUM UNLEADED Conditional DOLE WALLED Continuous Interstitial Mootoring 2360 7 390002322590225907 PT0004151 6,000 UB REGULAR UNLEADED Conditional DOUBLE WALLED Continuous Interstitial Monitoring 2362 6 390002322590225906 PTOOG4150 6,000 90ErfDD �02$, Underground Storage Tank Permit Conditions I) The Perto Operate will become void if Annual Permit Fees and Service Fees are not paidand/or the UST system(s)fails to remain in compliance with these Permit Conditions. Permit 2) In order to maintain the operating permit,the owner and operator shall Wniply with the H&S Code,Div.20,Chap.6.7 and 6.75;and CCR Title 23,Chap.16 and Ig,as well as any conditions established by San Joaquin County. . k 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 3) If the Tank Operawr(s)is different from the Tan the Tank Owner and tank Operator receive a copy of the permit. 4) Written Monitoring Procedures and an Emergency Response Plan must be approved by the Environmental Health Department(EHD)and are considererd UST Permit Conditions. The approved monitoring,response,and plot plain shall be maintained onsite with the pera t 5) The Peruttee shall comply with the monitoring procedures referenced in this permit 6) The Permittee shall perform testing and preventive maintenance on all leak detection monitoring equipment annually,or more Irequently ifspecified by the equipment manufacturer,and provide documentation of such servicing to this office. 7) In the event of a spill,leak,or other unauthorized release,the Permit"shall comply with the requirements of Title 23 CCR Chap.16,Art.5,and the approved Emergency Response Plan. g) Written records ofall 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 dale the monitoring was performed 9) The EHD shall be notified of any change in ownership or operation of the UST system within 30 days ofsuch 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 subject to review,modification or 11) L4Y89&DAn,repair and/or removal permits are required from the EHD prior to any change,repair or removal of UST system equipment 12) The Perm it"shall submit an annual report documenting compliance with the UST 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 ofany other Federal,State or Local agency. 14) A"Conditional"Permit may be revoked if corections 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: LUKOSE, JOSEPH DBA: COLLEGEVILLE MARKET & CAFE Tank Owner: PHILIP, MATHEWIJAMES THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES Facility ID FA0001457 Regulated Facility. COLLEGEVILLE MARKET &CAFE 13521 E MARIPOSA RD Account ID AR000 STOCKTON, CA 95215 Issued 511120033 Billing Address: COLLEGEVILLE DIARKET & CAFE 13521 E MARIPOSA RD STOCKTON, CA 95215 7023.rpt