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SAN JOA.,,JIN COUNTY PUBLIC HEALTH S'VICES 304 E.WEBER AVE.,THIRD FLOOR • STOCKTON,CA 95202 • PHONE(209) 468-3420 KAREN FURST,M.D., M.P.H., HEALTH OFFICER DONNA RERAN.R.E.H.S.,DIRECTOR ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY PERMIT TO OPERATE errtu[ Valid ogram ermlt pro ram Code and Description Record ID Number g 111100 To 12131100 PR023163 2300-UNDERGROUND STORAGE TANK FACILITY Underground Storage Tank Program: California Health and Safety Code Div_20,Chap_6.7 and Title 23 California Code of Regulations Chap.ul e ec Ion Pit- IrWr IYP cr 81 n rve 2360 5 390002315320506755 PT0009045 12,000 PREMIUM UNLEADED Active DOUBLE WALLED VISUAL CHECK 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 systems)fails to remain in compliance with these Permit Conditions. 2) In order to maintain the operatin er ut,the permit)alder shall comply with the H&S Code,Div.20,Chap.6.7 and 6.75;and CCR,Title 23,Chap. 16 an 18,as well many conditions established by San Joaquin County. 3) If the Tank Opemtor(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 ensure that both the Tank Owner and tapnk Operator receive a copy of the permit. ((Pp we 4) UWritten ST Penni Conditions. Copies of the Procedures and Emergency Responsbe e Plan muoved st bees had Environmental permit orbesaai[able forHS/Ereviewand/orinrspection $) �rhe UST site. he Yenmttee shall comply with the monitoring procedures refertenced in this permit. 6) The Permittee shall perform testing and preventive maintenance on all leak detection monitoring equipment annually,or more frequently if specified by the equipment manufacturer,and provide documentation of such servicing to this office. 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 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 oro peration of the UST system within 30 days of such change. 10) Upon any changein equipment,design or operation of the UST system(including change in tank contents a usage),the Permit to Operate will be subject to review,modification or revocation. 11) Concoction,repair and/or removal permits are required from the PHS/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 of the issuance 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. 14) A"Conditional'Permit may be revoked if corrections specified on the inspection report are not completed by the date(s) indicated. PERMITS TO OPERATE are NOT TRANSFERABLE and may be SUSPENDED or REVOKED for cause. PERMIT(s)Valid only for: CIRCLE K STORES INC DBA: CIRCLE K STORES Tank Owner: TOSCO MARKETING CO TIIIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON TRE PREMISES Facility ID FA0000185 Regulated Facility: CIRCLE K STORE#1205 Account ID AR0000184 16470 CAMBRIDGE DR Issued 912812000 LATHROP, CA 95330 Billing Address: ATTN : CIRCLE K STORES INC CIRCLE K STORE#1205 PO BOX 52085 PHOENIX, AZ 85072-2085 7023.rpt 1� �mow