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V OF <br /> SAN JOr UIN COUNTY PUBLIC HEALTH 14WICES <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 HERRN, 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 -Pit. Permit <br /> Record ID Number Program Code and Description Valid <br /> PR0231129 2300-UNDERGROUND STORAGE TANK FACILITY 1/1/01 To 12/31/01 <br /> Underground Storage Tank Program: <br /> California Health and Safety Code Div_20,Chap_6.7 and Title 23 California Code of Regulations Chap. 16_ _________ _________ ___________ <br /> PIE Tank# Tank Record ID Permit# Capacity Contents Permit Status System Type Leak Detection <br /> 2360 7 390002311290508185 PT0009581 10,000 MIDGRADE UNLEADED Active DOUBLE WALLED TANK TESTING <br /> 2360 6 390002311290508184 PT0009580 10,000 REGULAR UNLEADED Active DOUBLE WALLED TANK TESTING <br /> 2362 5 390002311290508183 PT0009579 10,000 PREMIUM UNLEADED Active DOUBLE WALLED TANK TESTING <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 b 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 /> any conditions 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 UST 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 ofsuch 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 /> 8) Written records of all monitoring performed shall be maintain ed on-site by the operatorand be available for inspection for a period of at least three)Ears 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 of this 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 maybe 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: CIRCLE K STORES INC <br /> DBA: CIRCLE K STORES <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: CIRCLE K STORE#5448 Facility ID FA0001817 <br /> 3202 W HAMMER LN Account ID AR0001821 <br /> STOCKTON. CA 95209 Issued 3/29/2001 <br /> Billing Address: ATTN : CIRCLE K STORES <br /> CIRCLE K STORE#5448 <br /> PO BOX 52085 <br /> PHOENIX, AZ 85072-2085 <br /> 7023.rpt <br /> I <br />