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SAN JOAQUIN COUNTY ENVIRONMENTAL HEMXH DEPARTMENT 304 E-Weber Ave.,Third Floor•Stockton,CA 95202-2708•Phone(209)468-3420 Donna Herm,R.EH.S.,Director ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY PERMIT TO OPERATE Prnnit Program Permit Valid Record M Number Program Code and Description 213112003 PRO518288 2300-UNDERGROUND STORAGE TANK FACILITY 11112003 To 1 Underground Storage Tank Proaram• - Califomia Health and Safely Code,Div.20,.Chap.6.7 and Title 23,Calitomia Code of Regulations,Chap,16.-----__--_.__________---__._---_----------------------- p/E Tank# Tank Record ID Permit# Capacity Contents Permit Status System Type Leak Detection PREMIUM UNLEADED Active,billable DOUBLE WALLED C /mora Intersd9al MonOori 19 2360 3 390005182880515629 PT0011950 20,000 REGULAR UNLEADED Active,billable DOUBLE WALLED Conunvoms mnit tersuuai Mooring 2360 2 390005182880515628 PT00119420,000 REGULAR UNLEADED Active,billable DOUBLE WALLED Continuos Intersuuai M nonng 2362 1 390005182880515627 PT0011948 20,000 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 operating pemdt the owner and operator shall comply with the H&S Code,Div.20,Chap.6.7 and 6.75;and CCR Title 23,Chap.16 and Ie,as well as any conditions established by San Joaquin County. . Owner,or if the Permit to Operate is issued to a person other than the owner or operator of the tank the Permittee ll more that both 3) If the Tank Opemtor(s)is different from the Tank the Tank Owner and tank Operator receive a copy of the permit 4) Written Monitoring Procedures and an Emergency Response Plan most be approved by the Envir mrenul Health Department(EHD)and am considererd UST Pemdt Conditions. The approved monitoring,response,and plot plans shall be maintained onsite with the permit 5) The Pemtitue,shall comply with the monitoring procedures referenced in this pemdt 6) The Pennine shall perform testing and preventive maintenance on all leak detection monitoring equipment annually,or mom 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 g) 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 dace years from the date the monitoring was performed. 9) The EHD shall be notified of any change in ownership or operation of the UST 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 11) Mfb'd&glbn repair and/or removal perrmus are required from the EIB)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 P mmt 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: COSTCO WHOLESALE CORPORATION DBA: COSTCO WHOLESALE CORP THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES Facilityll) FA0013810 Regulated Facility. COSTCO GASOLINE FAC#658 A23 3250 W GRANT LINE RD Account 11) R0023. TRACY, CA 95377 ssaed 5/1/2003 Billing Address: COSTCO GASOLINE FAC #658 999 LAKE DR ISSAQUAH, WA 98027 7023 rpt