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SAN JOAQL`.�� COUNTY ENVIRONMENTAL HEAL1 i.-!)EPARTMENT
<br /> ' 600 E. Main St. • Stockton, CA 95202-3029 • Phone(209)468-3420
<br /> Donna Heran, R.E.H.S.,Director
<br /> �3as ENVIRONMENTAL HEALTH
<br /> SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY
<br /> PERMIT TO OPERATE
<br /> Program Permit Permit
<br /> a Record ID Number Program Code and Description Valid
<br /> PRO513649 PT0009844 2220-SMALL QUANTITY HAZARDOUS WASTE GENERATOR FACILITY 1/1/2012 To 12/31/2012
<br /> Hazardous Waste Generator Program`
<br /> ^' In order to maintain the permit to operate, Hazardous Waste Generators shall comply with California Health and Safety Code,Div.20,Chap.6.5,Art.2-13,
<br /> Sec.25.100 et seq,_and Title 22,California Code of Regulations,Chap.20_
<br /> — — — —
<br /> PR0231331 2300-UNDERGROUND STORAGE TANK FACILITY
<br /> 1!1/2012 To 12/31/2012
<br /> Underground Storage Tank Program:
<br /> California Health and Safety Code, Div.20,Chap._6.7 and Title 23,California Code of Regulations,Chap_ 16 .
<br /> ---------- - - -- - ------ - --------
<br /> P/E Tank# Tank Record ID Permit# Capacity Contents Permit Status System Type Leak Detection
<br /> 2362 3 390002313310133103 PT0005118 5,000 DIESEL Active,billable DOUBLE WALLED Continuous Interstitial Monitoring
<br /> 2350 4 390002313310515887 PT0020176 20,000 DIESEL Active, billable DOUBLE WALLED Continuous Interstitial Monitoring
<br /> Underground Storage Tank Permit Conditionsh „fir
<br /> I) The Permit to Operate will become void if Annual Permit Fees and Servroe Fees are not pard and/or the U$T system(s)fails to remain in compliance with these Permit Conditions. `
<br /> 2) In order to maintain the operating permit,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 18,as well as any conditions
<br /> ' established by San Joaquin County,
<br /> ria ,3) If the Tank Operator(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
<br />} the Tank Owner and tank Operator receive a copy of the permit.
<br /> s >K A) Written Monitoring Procedures and an Emergency Response Plan must be approved by the Environmental Health Department(EHD)and are considererd UST Permit Condittons. The approved
<br /> r monitoring,response,and plot plans shall be maintained onsite with the permit.
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<br /> , ) The Permittee shall with the monitoring procedures referenced in this permit ra5Q:
<br /> "r 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
<br /> provide documentation of such servicing to this office.
<br /> :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.
<br /> 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
<br /> performed.
<br /> 9) The EHD shall be notified of any change in ownership or operation of the LIST system within 30 days of such change
<br /> 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 on
<br /> revocation.
<br /> 11) Construction,repair and/or removal permits are required from the EHD prior to any change,repair or removal of UST system equipment ars " r + v ;* #'
<br /> 12) This Permit to Operate shall not be considered permission to violate any laws,ordinances or statutes of any other Federal,State or Local agency ¢ ,�. � ���< .
<br /> s�kylss,-: 13) A"Conditional"Permit may be revoked if corrections specified on the inspection report are not completed b the dates indicated •�`'
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<br /> PERMITS TO OPERATE may be SUSPENDED or REVOKED for cause.
<br /> PERMIT(s)Valid only for: LODI MEMORIAL HOSPITAL
<br /> ' wK DBA: LODI MEMORIAL HOSPITAL -WEST ' " '
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<br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES
<br /> LODI MEMORIAL HOSPITAL Facility ID FA0000513
<br /> Regulated Facility: , ,` '' � t ,
<br /> r 975 S FAIRMONT AVE ,trrti Account ID AR0000512
<br /> LODI CA 94240 *�� � � .t<i� r� ' r Is ued
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<br /> Billing Address: ATTN GAYLE MOSES SAFETY/SECURITY MG'
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