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SAN JOAQUIN COUNTY PUBLIC HEALTH c?RVICES 304 E. WEBER AVE&IRD FLOOR • STOCKTON, CA 95202 • AE (209) 468-3420 KAREN FURST, M.D., M.P.H., HEALTH OFFICER DONNA HERRN, R.E.H.S., DIRECTOR ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY PERMIT TO OPERATE rogram ernut Program Code and Description ernul Record ID Number g Valid PR023143 2300-UNDERGROUND STORAGE TANK FACILITY 1/1/00 To 12/31/00 Underground Storage Tank Program: California Health and Safety Code Div.20,Chap.6.7 and Title 23 California Code of Regulations Chap. 16. _ ank P I an k Kecordcrnu apacr y L on ens Pernutstatus aystern I ype --- ----A7 390002314380508393 P10009683 6,000 PREMIUM UNLEADED ctive DOUBLE WALLED 2360 6 390002314380508392 PT0009682 6,000 DIESEL Active DOUBLE WALLED 2360 5 390002314380508391 PT0009678 12,000 REGULAR UNLEADED Active DOUBLE WALLED Underground Storage Tank Permit Conditions 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 Conditions. f ., 2) In order to maintain the operatingpermit,the permit holder shall comply with the H&S Code,Div.2Q Chap.6.7 and 6.75;and CCR,Title 23,Chap. 16 and 18,as well as any conditions established by San Joaquin County. 3) If the Tank Operator(s)is different fronr the Tank Owner,or if the Perm it to Operate is issued to a person other than the owner or operator of the tank,the Permittee shall ensure that both 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 Division(PHS/EHD)and are considererd UST Penn it Conditions. Copies ofthe Procedures and Emergency Response 11fan must be attached to this permit or be available for review and/or inspection 5) lh4ermTttee shall comply with the monitoring procedures referrenced in this permit. 6) The Permittee shall perform testing and preventive maintenance on all leak detection monitoring equipment annually,or more frequently ifspecified by the equipment manufacturer,and provide documentation of such servicing to this office. ir, 7) In the event of a spill,leak,or other unauthorized release,the Pennitee shall comply with the requirements of Title 23 CCR,Chap. 16,Art.5,and the approved Emergency Response Plan, 8) Written 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 years from the date the monitoring was performed. 9) The PHS/EHD shall be notified of any change in ownership or operation of the LIST 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. 1 1) Construction,repair and/or removal permits arc required from the Pl IS/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 Wit. of this 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. qF` 14) A"Conditional"Permit may be revoked if corrections specified on the inspection report are not completed by the date(s) indicated. t" J, x PERMITS TO OPERATE are NOT TRANSFERABLE and may be SUSPENDED or REVOKED for cause. PERMIT(s)Valid only for: CARDOZA, ED & DELORES Tank Owner: EDWARD & DELORES CARDOZA ']'HIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES Regulated Facility: SUPER STOP MARKET* Facility ID FA0003716 290 N MAIN ST#C Account ID AR0003295 MANTECA, CA 95336 Issued 1011012000 ."t Billing Address: ATTN : ED & DELORES CARDOZA CARDOZA, ED & DELORESjZ PO BOX 1022 .,x MANTECA, CA 95336 - 7023.rpt