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r <br />SAN JOIN COUNTY PUBLIC HEALTH #VICES <br />304 E. WEBER AVE., THIRD FLOOR • STOCKTON, CA 95202 • PHONE (209) 468-3420 <br />KAREN FURST, M.D., M.P.H., HEALTH OFFICER <br />DONNA HERAN, R.E.H.S., DIRECTOR ENVIRONMENTAL HEALTH DIVISION <br />ENVIRONMENTAL HEALTH <br />SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY <br />PERMIT TO OPERATE <br />rogram Permit Permit <br />Record ID Number Program Code and Description Valid <br />PR023134 2300 - UNDERGROUND STORAGE TANK FACILITY 1/1/00 To 12/31/00 <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 />-- ----------------------------P--y------------------------------y---YP----------------- <br />an an ecor Permit Capacity Contents error Status sem a LeaK Detection <br />23bu b 390002313420501804 PT0009313 10,000 PREMIUM UNLEADED Active <br />2360 5 390002313420507803 PT0009312 10,000 PREMIUM UNLEADED Active DOUBLE WALLED INTERSTITAL MONITOR <br />2360 4 390002313420507802 PT0009311 20,000 REGULAR UNLEADED Active DOUBLE WALLED AUTOMATIC TANK GUAGE <br />Underground Storage Tank Permit Conditions <br />l) The Permit to Operate wil I become void if Annual Permit Fees and Service Fees are not paid and/or the UST system(s) fails to remain in compliance with <br />these Permit Conditions. <br />2) In order to maintain the operatingpermit, the permit holder shall comply with the H&S Code, Div. 20, Chap. 6.7 and 6.75; and CCR, Title 23, Chap. 16 and <br />18, as well as any conditions established by San Joaquin County. <br />3) Ifthe Tank Opemtor(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 <br />Permittee shall ensure that both the Tank Owner and tank Operator receive a copy of the permit. <br />4) Written Monitoring Procedures and an Emergency Response Plan must be approved by the Environmental Health Division (PHS/EHD) and are considererd <br />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 <br />tm <br />hsUST site <br />5) . <br />erttee shall comply with the monitoring procedures referrenced in this permit. <br />6) The Permittee shall perform testing and preventive maintenance on all leak detection monitoring equipment annually, or more frequently ifspecified by the <br />equipment manufacturer, and 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 <br />approved Emergency Response Plan. <br />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 <br />from the date the monitoring was performed. <br />9) The PHS/EHD shall be notified of any change in ownership or operation of the UST 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 <br />review, modification or revocation. <br />11) Construction, repair and/or removal permits are required from the PHS/EHD prior to any change, repair or removal of UST system equipment. <br />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 <br />of this permit. <br />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. <br />14) A "Conditional" Permit may be revoked if corrections specified on the inspection report are not completed by the date(s) indicated. <br />PERMITS TO OPERATE are NOT TRANSFERABLE <br />and may be SUSPENDED or REVOKED for cause. > <br />PERMIT(s) Valid only for: GRAFFIGNA, PETE 8r BILL <br />DBA: FLAME MINI MART <br />Tank Owner: GRAFFIGNA & GRAFFIGNA <br />THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br />Regulated Facility: FLAME MINI MART Facility ID FA0000392 <br />1301 W KETTLEMAN LN Account ID AR0000391 <br />LODI, CA 95242-4572 Issued 9/28/2000 <br />Billing Address: ATTN : GRAFFIGNA, PETE <br />FLAME MINI MART <br />1301 W KETTLEMAN LN <br />LODI, CA 95242-4572 <br />7023.rpt . 0 <br />