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UST Program: Facility Information Permit Application: CERS Regulator Page 1 of 2 <br />• is <br />California Environmental Reporting System: Regulator vicki mccartnev's Accoun Sign Ou Tools Reports Help <br />Submittals Facilities Businesses Regulators Compliance Responders Reports <br />UST Facility Operating Permit Application: San Joaquin General Hospital <br />Horne N Submittal Search )) Submittal: 10/14/2015 (106432781 D UST: UST Facility Operating Permit Application (Not Accepted) <br />—Submittal Element Histo <br />Submitted for CERS ID 10643278 on 10/14/2015 8:13AM by Ann Mane Addlerof San Joaquin General Hospital (French Camp CA) <br />Submittal was NotAccepted on 10/19/2015 by NG, WILLYfor San Joaquin County Environmental Health <br />Comments by regulator: Please resubmit with a corrected Facility Information submittal. If you have any questions, please contact Aris Veloso at <br />aveloso@sjcehd.com or (209) 468-3453. <br />IN <br />Type of Action- <br />confirmed/Updated Information <br />San Joaquin General Hospital <br />500 W Hospital Rd <br />French Camp , CA 95231 <br />Facility Type <br />Other <br />BOE Number <br />44024562 <br />Is the facility located on Indian Reservation/Trust lands? <br />No <br />Property Owne <br />Owner Name Phone <br />San Joaquin General Hospital 209-468-7063 <br />Mailing Address <br />500 W. Hospital Rd <br />City State ZIP/Postal Code Country <br />Frencho Camp CA 95231 United States <br />Tank Operato <br />Tank Operator Name Phone <br />San Joaquin General Hospital 209-468-7063 <br />Mailing Address <br />500 W Hospital Rd <br />City State ZIP/Postal Code Country <br />French Camp CA 95231 United States <br />Tank Owne <br />Owner Name Phone <br />San Joaquin General Hospital 209-468-7063 <br />Mailing Address <br />500 W Hospital Rd <br />City State ZIP/Postal Code Country <br />French Camp CA 95231 United States <br />Tank Owner Type <br />County Agency <br />Return to Submittal <br />—Permit Holder Information <br />Permit Holder Notification Information Supervisor of Division, Section, or Office (Required for Public Agencies Only) <br />Facility Owner San Joaquin General Hospital <br />Responsibility <br />Indicate which approved mechanism(s) are being used to showfinancial responsibility either as contained in the federal regulations (40 CFR, Part 280, Subpart H, Sections <br />280.93 through 280.107) or CCR, Title 23, Division 3, Chapter 18, Section 2808.1. <br />Self-insured <br />perSurety Bond State Fund and CFO Letter Other Mechanism <br />Yes `_ J] No Yes No <br />Guarantee Letter of Credit State Fund and CD - <br />No No No <br />Insurance Exemption Local Government Mechanism <br />No No No <br />I certify that the information provided in this UST submittal is accurate and current, and that this facility complies with all applicable Underground Storage Tank <br />requirements. <br />Applicant Name Applicant Title Applicant Phone Date Certified <br />Jesse Escotto Plant Engineer 209-468-7063 - <br />Created By: Ann Marie Addler on 10/142015 8:10 AM <br />Last Updated By: Ann Marie Addler on 10/14/2015 8:11 AM <br />Return to Submittal <br />Version 223.0009 1 Enhancements 1 CERS Central Diagnostics I Conditions of Use I Privacy Policy I Contect I Help <br />California Environmental Reporting System: Business 10 2015 California Environmental Protection Agency <br />CERS Technical Support: Request Technical Assistance <br />7si I '15� CERS Help I , Notifications <br />https:Hcersregulator.calepa.ca.gov/Business/I 67973/Facility/10643278/Submittal/UST/ 134... 12/3/2015 <br />