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SAN JO IN COUNTY PUBLIC HEALTH SI&VICES 304 E.WEBER AVE., 1111Rt) FLOOR • STOCKTON,CA 95202 • PHONE(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 30AQUIN COUNTY CERTIFIED UNI FI ED PROGRAM AGENCY PERMIT TO OPERATE Pro Permit Permit Record.iD Number Program Code and Description Valid PRO61364 PT0009844 2220-SMALL QUANTITY HAZARDOUS WASTE GENERATOR FACILITY 1/1/00 To 12/31/00 Hazardous Waste Generator Program: California Health and Safety Code Div.20,Chap.6.5,Art.2-13 Sec.25100 et seq,and Title 22 California Code of Regulations,Chap.20. OR023133 �ERGROUND STORAGE TANK FACILITY 111100 To 12/31/00 Underground Storage an< rogram: California Health and Safety Code Div.20,Chap.6.7 and Title 23 California Code of Regulations Chap. 16. an anK Recoraerne apace y Contents Pernut Status 3 390002313310133103 PTOU05118 5,000 DIESEL Active BOE 11 #4 024 t, Underground Storage Tank Permit Conditions 1) The Permit to Operate will become void if Annual PermitPees 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 holder shall comply with the i-i&S Code,Div.20,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) 1 f the Tank Opperators)is different from the Tank Owner,or if the Penn it to Operate is issued to a person other than the owner or operator of the tank,the Permittee sha11 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 Permit Conditions. Copies of the Procedures and Emergency Response Plan must be attached to this permit or be available for review and/or inspection 5) itlth UST site. me F'ermrttee 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 if specified by the equipment manufacturer,and provide documentation ofsuch 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 fora period ofat 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 of the anniversary dale 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: LODI MEMORIAL HOSPITAL THIS FORM MUST BF,DISPLAYED CONSPICUOUSLY ON THE PREMISES Regulated Facility: LODI MEMORIAL HOSPITAL Facility ID FA0000513 975 S FAIRMONT AVE Account ID AR0000512 LODI, CA 94240 Issued 10/4/2000 Billing Address: ATTN : DONNA MCCAULEY LODI MEMORIAL HOSPITAL 975 S FAIRMONT AVE LODI, CA 95240 7023.rpt