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<br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPA$ .11�N�'' r + It
<br /> 6P0 E. Main St. • Stockton, CA 95202-3029 94Ptte{209)..4b$- 420< ryx
<br /> A Donna Heran,R.E.H,S., Director
<br /> 1 ,
<br /> ENVIRONMENTAL HEALTH
<br /> tI JOAQUIN COUNTY CERTIFIED UNIFIED FROGRAM AGENfY '
<br /> PERMIT TO OPERATE r
<br /> Program Permit `.
<br /> Program Code and Description Permit
<br /> Record ID Number g P Valid
<br /> PRO513649 PT0009844 2220 SMALL QUANTITY HAZARDOUS WASTE GENERATOR IFACrtt71(" 1/1/2011To 12/31/2011
<br /> Hazardous Waste Generator Program: fill
<br /> In order to malnt4in the-,pgrmit to operate, Hazardous Waste Generators shall comply with Caltfgmla His alth and'Saf0,ty"Code,Div.20,Chap,6.5,Art.2-13,
<br /> Sec_25100 et as �Irrtl'�itle 22,California Code of ReOulations,Cha _20: `.
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<br /> PR0231331 _," 2300-UNDERGROUND STORAGE TANK FACILITY 1/1/2011 To 12/31/2011;
<br /> Underground Storage Tank Program:
<br /> California Health and Safety Code, Div.20,Chap.`6.7 and Title 23, California Code of RedIulations Chap 16.
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<br /> Tank
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<br /> P/E Tank# Tank Record ID Permit# CapacityContents Permit Status Syste!pXype Leak Detection
<br /> 2362 3 390002313310133103 PT000511$, 5,000 DIESEL Active,billable DOUSM ALLED Continuous Interstitial Monitoring
<br /> 2350 4 390002313310515887 PT002pJJ6,7" 20,000 DIESEL Active,billable DQ11^E'WALLED Continuous Interstitial Monitoring ;
<br /> k�;�4024651 ,
<br /> Underground Storage Tank Permit Conditions
<br /> 1) The Permit to Clperate will become void if Annual Permit Fees and Servaees are not paid and/or the US sysfeM(s�fails to remain in GOmpljgpe¢�y►th hese�'IutptClGptls '
<br /> 2) In order tia t tain the operating permit,the owner and operatgt shall comply.*#i the H&S Code,Div.20,Chap.6.7 and 6.75;and CCR,,Title ,C'8p:t6 411d I8 as# 11 aS ant
<br /> establishbd by San Joaquin County.
<br /> Xhf►R&ns
<br /> 3) If the Tank Operator(s)is different from the Tank Ownex,sin ififie PerMii to Operate is issued to a person otligllii}tithe owa t�tproftl tank'tliQPeRhtttGe' 11 ensuie ftiat both 5•
<br /> the Tank Owner and tank Operator receive a copy of the penttit.
<br /> 4) Written Monitoring Procedures and an Emergency Response Plan must be approved by the Environmental Health Dep 9 rettst pt jF.FlDhal!tl a carend iJ$T Penton Gippd 6pgs:.The approved
<br /> monitoring,response,and plot plans shall be maintained onsite with the permit. , 4
<br /> 5) The Permittee shall comply with the monitoring procedures referenced in this permit.
<br /> 6) The Permittee shall perform testing and preventive maintenance on all teak detection monitoring egt3ipmept annually,or igore fregiient#y if specified by the equiptiieptihignufao[urer,and
<br /> provide docuntegf*on of such servicing to this office.
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<br /> 7) In the,event,t aspitl,leak,or other unauthorized release,the Permitee shall comply with the,Fequirements of Title 23 CCR (hap+6,Ilrt 5,and the approved Emergency Response Plan
<br /> 8) Wntteft rccgt�&"qf all monitoring'performed sli{11be maintained on-site by the operato'i agd be'available for inspectiou.for:aperiod ofat Ieasi three years from the date the monnunng was 1 -
<br /> performed ".
<br /> 9) The EHD shall lie"nitti£ed of any change m ownership or operation of the UST system within 30 days of such change. !
<br /> 10) Upon any change-i equipment,desigtt,orgperation of the UST system(including change in tank contents or usage),the Perttitt'ta fJpetate will be subject to revlevk,'mAdtfcation or
<br /> r revocation.
<br /> 11) Construcuott repair and/or removal permits are required from die EHD prior to any change,repair or removal of UST system equipment.
<br /> 12) j hed�erauttee.shaltsubmit an annual report documenting compliance with the UST Permit Conditions within 30,da s of the date"of the issuance of this ennit.
<br /> y P
<br /> I;0`- Permit to Operate shall not be considered permission to violate any laws,ordinances or statutes of ;9ther Federal,3tatp pry Oral agency: C
<br /> 14)
<br /> A," itional"Permit may be revoked if corrections specified on the inspection report are not completedby,the datOIsij todtoat i.. ,
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<br /> PERMITS
<br /> ----- ---------PERMITS I"Q flt'ERATE may be SUSPENDED or REV9'!<ED for COUSe,''; ,
<br /> PERMIT(s)Valid only for. LODI MEMORIAL HOSPITAL
<br /> DBA: LODI MEMORIAL HOSPITAL-WEST Y
<br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES ;}
<br /> Regulated Facility: LODI MEMORIAL HOSPITAL Facility JD,:FA0000513 F
<br /> 975 S FAIRMONT AVE
<br /> Account lD AR0000512
<br /> LODI CA 94240 Issued 2/4/2011
<br /> Billing Address: ATTN GAYLE MOSES SAFETY/SE,CURITY MG
<br /> LODI MEMORIAL HOSPITAL
<br /> JI
<br /> 975-,S kIRM0NT AVE
<br /> LO_ C;nI: 95240
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