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SAN JOj' 1UIN COUNTY PUBLIC HEALTH "RVICES 304 E. WEBER AVE., HIRD FLOOR • STOCKTON, CA 95202 • P'dONE (209) 468-3420 KAREN FORST, 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 ogramermit cora'( RecordlD Number Program Code and Description Valid PR023183 2300 - UNDERGROUND STORAGE TANK FACILITY 1/1/00 To 12/31100 Underground Storage Tank Program: California Health and Safety Code Div. 20, Chap. 6.7 and Title 23 California Code of Regulations Chap. 16. 2360 2 390002318300183002 PT0006548 1,000 UNLEADED Active 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. 2) In order to maintain the operating permit, the permit holdershall comply with the H&S Code, Div. 20, Chap. 6.7 and 6.75; and CCR Tide 23, Chap. 16 and 18, w well as any conditions established by San Joaquin County. 3) Ifthe Tank 0 erator(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 rm Peittee 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 considerer( UST Permit Conditions. Copies of the Pmcedures and Emergency Response Plan most be attached to this permit or be available for review and/or inspection 5) �th UST site. loe 5'ertnittee 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 Pemnitce 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 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 revocation 11) Construction, 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 ofthe 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: BOZZANO, LINO DBA: THREE PALMS GROCERY THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES Regulated Facility: THREE PALMS GROCERY" 6732 E HWY 88 STOCKTON, CA 95215 Billing Address: ATTN: BOZZANO, LINO THREE PALMS GROCERY' 2891 N ARATA RD STOCKTON, CA 95205 7023.rpt v 1.W Facility ID FA0004030 Account ID AR0003669 Issued 9/29/2000