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<br /> SAN JOA UII�Z O '
<br /> r Q UNTY ENtQNMENTAL HE DEPARTMENT
<br /> a f
<br /> 600 E. Main St. • Stocktgpy A 95.2 -3029• Phone(209)468 342�i7.
<br /> _
<br /> Donna Ier14,12,�:H.S.,Director tt
<br /> 5 ENVIRONM� TTAL � �� '� �'
<br /> SA1V JOA UIN COUNTY
<br /> Q,. CG*,IVIED UNIII�P'It4CRAMi#CFA1eY
<br /> #3rogram Permit
<br /> -�',t2ecord 7l) _ ^:Number Program£ode wrist Pic=Fhoa � �-
<br /> V, I'd
<br /> PRO514045 PT0010 40 2220 SMALL 4"NTITY H�ZrgftR4US WA$T GEI!fER TQR F,�1CH;tTY '11/20"142.70 12/3112012
<br /> Hazardous Waste Genelafor Program: t`..
<br /> In order to maintain the jler4nit to operate,Haz4dlz s Wa&te Generators shall co(nply with CaIlfQrpla hlealth and SafetyCode,Div.20,Chap.6,5,Art.2-13
<br /> Sec 21tTset �wd�3tle2 Cahfornta CPdef Reut�ttta chap 20 _
<br /> . 1/1/2012 To 12/31/2012
<br /> 1.
<br /> '�1�,�,.yy 1�R'jtl * ,2300 Et�a4'IOf, D,,�t1,�2AGE TAI !(FA ILITY _ r
<br /> t t
<br /> Cahforma'Health arld Safe Code Dlv 20 Chap �`7 wild Tltle 23 Califomla`Gade of Re ulations C 16 1
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<br /> P/E Tank# Tank RecordGapaet
<br /> ty tenth ; -_ .�tppt>I S404, $ystem Type Leak Detection
<br /> 2352 9 390002310700515783 PTOQIQ 8� $, PRNEMtU •UN .4 lve,.bUta4 �U@l E wf+Lt a Coptinuous Interstitial Monitoring
<br /> 2350 10 3900023107005157$4 I�TOI�167�EI 1 ,QlaQfaUtAk lJNt EAtt1lEQ' f bllt� (Q�IdL '.4YAL LEQ Continuous Interstitial monitoring
<br /> 2350 11 390002310700515785 . . 157016:7 F 7;QQQ QIE3E{. Actty ,b1�11@. DDkt86E 1NN k�Q. Continuous tnterstdiai Monitoring
<br /> Underground Storage Tank Permit'<Ctllld�lti6_JV
<br /> ,
<br /> 1) The Permit to Operate will becoffiC void if Atuiital"Permit Fees and$etyt�e Fgaren pauiflricl/ozlhe UST"1�����M�F���)s fails to remaiA u1 cotppltatscCWith these Permit Conditions
<br /> 2) In order to maintain the operating p !t.the own@r and operator shall comply die 6&S,Code,Div.20,Chap.65;and CCR,Title 23,Chap Iband 18,as well as any conditions
<br /> established by San Joaquin County,,.
<br /> 3) If the Tank Operator(sj ;l stent from the Tank Owner,or if the Permit tP,Qperate j$_ ed to a person other tt t}tiS A> or opet;totolfioc't4alt=tlte'Permittee shall ensure that but
<br /> the Tank Owner and tattk rV�`-tltor receive a copy of the permit.
<br /> 4) Written Monitoring Proceduro-;ind an Emergency Response Plan must be approveO by the Enviromneutal Health Depart ;() t,sttp eowsldererd UST Pemtit Conditions. 'rhe approves)
<br /> monitoring,response,and plot plans shall be maintained onsite with the pemttt ` 7
<br /> 5) The Permittee shall comply with the monitoring procedures referenced in tltts permit '
<br /> 6) The Permittee shall perform testing and preventive maintenance on all leak daFcpgA,;Agni�onq$et�titpt�uptit ttAnually,or rrr frequently if specttry tag gquipment manufacturer,and a ,
<br /> provide documentation of such servicing to this office. "
<br /> 7) In the event of a spill,leak,or other unauthorized release,the Pennitee shall comply wall[ttlp:t0glttrittcspt�pip 14t)p;2 i CGR, hap.36-Att ;:�1id'tfie approved Emergency Response Plan i
<br /> 8) Written records of all monitoring performed shall be maintained on-site by the operator anti."it n5le r u►gpeation fora i of pt l ;three years from the date the monitoring was `
<br /> performed
<br /> 9) The EHD shall be notified of any change in ownership or operation of the UST system within3Q days of syeba>a$e, #< s F
<br /> 10) Upon any changg tp etlwltyptnent,design or opgmjjon of the UST system(incl an in tank cont Petnptt tp wrt!tie 5.
<br /> revocation. �� pFee zub�ect to review,modification or
<br /> �.�, f ♦ ,_
<br /> Ll) Constrttc tepatrati�t(/or>i�aioval permits are rtyr�d from,thg EHD prior to tm�change tpp8tr or removal of U$C axstwp egtnpmatt y
<br /> 12) This PPamtt IP Qp4tal shall not be constdtsred. rrmtsglott tP violate jast�"ardttelttces Ar stalµte pf aAyA'd r)ieEietak� to ori tical agonc�
<br /> 13jv A'Co�tdttt +P�rtntt 'maybe retcokedSfootreattags tried© thepns QA azenotcom r
<br /> report Iflt ted hY daxi ttldtcated.
<br /> 1
<br /> PERMITS TO OPERATE may be SUS PF„ or`REVOI�ED'for cause.
<br /> PERMIT(s)Valid only for: CALIFORNIA FUEL SUPPLY INC `
<br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES '1
<br /> COUNTRY CLUB 76 GAS STATION* Facility ID FA0006439 r '
<br /> Regulated Facility:
<br /> y' rR 2575 COUNTRY CLUB BLVp r` „� ry4 Account ID AR0008426
<br /> S I OCKTON CA 95204 t A >R xa 5 Issued l s�
<br /> 2/10!2012 a ,
<br /> x a x a+ _ t t r r t r err. a � p •'.. a z` + a s s :.� r.
<br /> Billing Address: ATTN CALIFORNIA FUEL SUPPLY zNC
<br /> vat, COUNTRY CLU3 76 GAS STATION* �k }�`' �5t eVti' r �r r,r2y e4rl r : �vyW £e&+*ryrr
<br /> ' r 587 YGNACIO VALLEY RD
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