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r <br /> SAN JOAN , N COUNTY PUBLIC HEALTH SICES <br /> 304 E.WEBER AVE.,THIRD FLOOR • STOCKTON,CA 95202 • PHONE (209) 468-3420 <br /> KAREN FURST, M.D., M.P.H., HEALTH OFFICER <br /> DONNA RERAN,R.E.H.S., DIRECTOR ENVIRONMENTAL HEALTH DIVISION <br /> ENVIRONMENTAL HEALTH <br /> SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY <br /> PERMIT TO OPERATE <br /> Program Permit Permit <br /> Record ID Number Program Code and Description Valid <br /> PR0231069 2300-UNDERGROUND STORAGE TANK FACILITY 1/1/01 To 12/31/01 <br /> Underground Storage Tank Program: <br /> California Healthand Safety Code Div.20,Chap_6.7 and Title-23-California Code of Regulations_ Chap._16--------------------- ------________ <br /> P/E Tank# Tank Record ID Permit# Capacity Contents Permit Status System Type Leak Detection <br /> 2360 5 390002310690508127 PT0009544 3,000 REGULAR UNLEADED Active DOUBLE WALLED INTERSTITAL MONITOR <br /> 2362 4 390002310690508126 PT0009543 9,000 REGULAR UNLEADED Active DOUBLE WALLED INTERSTITAL MONITOR <br /> Underground Storage Tank Permit Conditions <br /> 1) The Permit to Operate will become void if Annual Permit Fees and Service Fees are not paid and/or the UST system(s)fails to remain in compliance with these Permit <br /> Conditions. <br /> 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 well as <br /> anyconditions established by San Joaquin County. <br /> 3) If the Tank Operator(s)is different from the Tank Owner,or if the Permit to Operate is issued to a person other than the owner or operator of the tank,the Permittee shall <br /> ensure that both the Tank Owner and tank Operator receive a copy of the permit. <br /> 4) Written Monitoring Procedures and an Emergency Response Plan must be approved by the Environmental Health Division(PHS/EHD)and are considererd UST Permit <br /> Conditions. Copies of the Procedures and Emergency Response Plan must be attached to this permit or be available for review and/or inspection at the USr site. <br /> 5) The Permittee shall comply with the monitoring procedures referrenced in this permit. <br /> 6) The Permittee shall perform testing and preventive maintenance on all leak detection monitoring equipment annually,or more frequently if specified by the equipment <br /> manufacturer,and provide documentation of such servicing to this office. <br /> 7) In the event of a spill,leak,or other unauthorized release,the Permitee shall comply with the requirements of Title 23 CCR,Chap.16,Art.5,and the approved Emergency <br /> Response Plan. <br /> g) Written records of all monitoring performed shall be maintained on-site bythe operatorand be available for inspection fora period of at least three years from the date the <br /> monitoring was performed. <br /> 9) The PHS/EHD shall be notified of any change in ownership or operation of the UST system within 30 days of such change. <br /> 10) Upon any change in equipment,design or operation ofthe UST system(including change in tank contents or usage),the Permit to Operate will be subject to review, <br /> modification or revocation. <br /> 11) Construction,repair and/or removal permits are required from the PHS/EHD prior to any change,repair or removal of UST system equipment. <br /> 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. <br /> 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. <br /> 14) A"Conditional"Permit may be revoked if corrections specified on the inspection report are not completed by the date(s) indicated. <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: GOODWIN,JOSEPH E <br /> DBA: COUNTRY CLUB FOOD & FUEL <br /> Tank Owner: ELDER, PHIL <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: COUNTRY CLUB OOD &FUEL MINI MART Facility ID FA0001909 <br /> 1856 W COUNTRY 'VD Account ID AR0001916 <br /> STOCKTON. CA 95204 Issued 3/29/2001 <br /> Billing Address: ATTN : COUNTRY CLUB FOOD & FUEL <br /> COUNTRY CLUB FOOD & FUEL MINI MART <br /> 1856 W COUNTRY CLUB BLVD <br /> STOCKTON, CA 95204 <br /> 7023.rpt • <br />