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' SAN JOIN COUNTY PUBLIC HEALTH *VICES 304 E.WEBER AVE.,THIRD FLOOR • STOCKTON,CA 95202 • PHONE(209) 468-3420 KAREN FURST,M.D.,M.P.H., HEALTH OFFICER DONNA HERAN,R.E.H.S.,DIRECTOR ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY CERTIFIED OPERATE PROGRAM AGENCY Permit Valid Program 't Program Code and Description111/01 To 12/31/01 Record fl) PR0232259 230OINDERGROUND STORAGE TANK FACILITY Underground Storage Tank Program- _ Califgmia Health and Safety Code Div,20,Chap,6.7 and Tide 23 CalifomCon rsof RegulatiP ChSa s _--- -System .,I- 7_ Leak Detection P/E Tank# Tk Record ID Permit# Capacity PREMIUM uINLCADED Conditional DOUBLE WALLED INTERSTITAL MONITOR 2360 7 390002322590225907 PT0004151 4,000 UNLEADED Conditional DOUBLE WALLED INTERSTITAL MONITOR 2362 6 390002322590225906 PT0004150 8,000 BOEID#`44-024994"{:. ,. 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 U ST sys�m(s)fails to remain in compliance with these Permit Conditions. 2) 1n order to maintain the operating pemrft,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 we as any conditions established by San Joaquin County. 3) If the Tank Opemax(s)is different from the Tank Owner,or if the Permit to Operate is issued to a person other than the owner or operztor of the tank,the Permittee shall ensure that both the Tank Owner and tank Operator receive a copy of the permit. by the rd 4) Conditions.n Monitoring oprocedures c educes and a and Emmen Response Responsen mus Plan must be attat be ched to this Environmental ortbe availabletfor rrev wsand/oorr inspection at the consider sSt Permit ies 5) The Permittee shall comply with the monitoring procedures mferenced in this permit. O The Pertmttee shall perform testing and preventive maintenance on all leak detection monitoring equipment annually,or more frequently if specified by the equipment manufactumr,and provide documentation of such servicing to this office. 7) In the event of a spill,leak or other unauthorimd release,the Permitee shall comply with the requirements of Title 23 CCR,Chap.16,Art.S,and the approve ry mergen Response Plan. g) WriMn 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 Wars 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 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 submit an annual report documenting compliance with the UST Permit Conditions within 30 days of the anniversary date ofthe 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 am not completed by the date(s) indicated. PERMITS TO OPERATE are NOT TRANSFERABLE F-- and may be SUSPENDED or REVOKED for cause. PERMIT(s)Valid only for: LUKOSE,JOSEPH Tank Owner: PHILIP, MATHEW/JAMES THIS FORM MUST BE DISPLAYED CONhr1i.,UVu31-x ON THE PREMISES 1 Facility ID FA0001457 Regulated FaLLEGEVILLE MARKET &CAFE' Account ID AR0001456 21 E MARIPOSA RD Issued 3129/2001 STOCKTON. CA 95205 Billing Address: ATTN : PHILIP MATHEW COLLEGEVILLE MARKET&CAFE" 13521 E MARIPOSA RD STOCKTON, CA 95205 7029.rpt 0 0