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SAN JO#N COUNTY PUBLIC HEALTH &ICES 304 E.WEBER AVE.,THIRD FLOOR • STOCKTON,CA 95202 • PHONE (209)468-3420 KAREN FURST,M.D., M.P.H., HEALTH OFFICER DONNA RERAN,R.E.H.S., DIRECTOR ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH SAN JOAQUIN COUNTY CERTIFIED UNIFIED PROGRAM AGENCY PERMIT TO OPERATE Permit Program Permit Program Code and Description Valid Record ID Number PR0232397 2300-UNDERGROUND STORAGE TANK FACILITY 111101 To 12!31/01 Underground Storage Tank Program: California Health a_nd Safety Code Div.20,Chap_6.7 and Title 23 California Code of Regulations Chap. 16_ _--____----_ -------------------- P/E Tank# Tank Record ID Permit# Capacity Contents Permit Status System Type 2362 1 390002323970239701 PT0006752 8,000 DIESEL Active DOUBLE WALLED 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 holder 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 established by San Joaquin County. 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 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 at the UST site. 5) The Permittee 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 bythe equipment manufacturer,andprovide documentation of such servicingto this office. 7) In the event of a spill,leak,or other unauthorized release,the Permitee shall comply with the requirements of Tile 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 ofthe 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 date of the issuance ofthis 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: ST JOSEPHS MEDICAL CENTER CORP THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES 0003978 Regulated Facility: ST DOMINIC'S HOSPITAL/MANTECA Facility ID Account ID FAFA0003 78 03 1777 W YOSEMITE AVE Issued 3/29/2001 MANTECA. CA 95336 Billing Address: ATTN : ST DOMINIC'S HOSPIAL/MANTECA ST DOMINIC'S HOSPITAL/MANTECA 1805 N CALIFORNIA ST#407 STOCKTON, CA 95204 7023.rpt