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BILLING_2011-2018
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231906
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BILLING_2011-2018
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Last modified
9/8/2021 11:15:07 AM
Creation date
11/5/2018 3:42:14 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
2011-2018
RECORD_ID
PR0231906
PE
2361
FACILITY_ID
FA0003776
FACILITY_NAME
KWIK SERV*
STREET_NUMBER
420
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06202042
CURRENT_STATUS
01
SITE_LOCATION
420 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\K\KETTLEMAN\420\PR0231906\BILLING 2011-2015.PDF
QuestysFileName
BILLING 2011-2015
QuestysRecordDate
5/19/2017 11:21:46 PM
QuestysRecordID
3391302
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN (Page 2 of 2) <br /> VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING <br /> 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54a <br /> L CONTINUOUS ELECTRONIC MONITORING El2.FLOAT AND CHAIN ASSEMBLY [13.ELECTRONIC STAND-ALONE 90.546 <br /> [14.NO DISPENSERS ❑99.OTHER(S ify): <br /> PANEL MANUFACTURER_ ago-ss MODEL#: TGf �3m 49P56. <br /> LEAK SENSOR MANUFACTURER: -Q_ J 690x7 MODEL#(S):—79 Q — 40-59 <br /> DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS a.YES ❑b.NO 490'59 <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a.YES ❑b.NO 49060_ <br /> FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑b.NO 490.61 <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. a.YES ❑b.NO 49062 <br /> 2.UDC CONSTRUCTION[S 1.SINGLE-WALLED ❑2.DOUBLE-WALLED 490.63 <br /> IF DOUBLE WALLED: —490.648 <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: LILLIQUID ❑2.PRESSURE ❑3 VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a,YES ❑b.NO °90'606 <br /> VII.PERIODIC SYSTEM TESTING <br /> ❑ I. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49065. <br /> LEAKETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED-EVERY 36 MONTHS AS REUIRED. 23 CCR 2644.1 <br /> 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49666 <br /> 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490.67 <br /> VIII.RECORDKEEPING <br /> The following monitoring/maintenance records are kept for this facility: <br /> Alarm logs 490.68a ❑Visual Inspection Records 490.686 ❑Tank integrity testing results 490-6sc <br /> SIR testing results(and supporting documentation records). 490.68, ❑ Tank gauging results(and supporting documentation records). 4%-688 <br /> ❑ATG Testing results(and supporting documentation records).490481 ❑ Corrosion Protection 60-day logs 4%.6sg <br /> 'equipment maintenance and calibration records. 490fi81i <br /> LY.TRAINING <br /> iZI Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490fi9a <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) <br /> }9 THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-696 <br /> OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)40.69c <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49 %i <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69. <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION"490-691' <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490.698 <br /> ❑ OTHER(Specify):M69h,M69i <br /> This facility has a"Designated UST Operator"whohas passed the California UST System Operator Exam administered by the International Code Council(ICC). <br /> he"Designated UST Operator"will train facility employees in the proper operation and maintenance of the UST systems annually,and within 30 days of hire.This <br /> training will include,but is not limited to,the following: <br /> > Operation of the UST systems in a manner consistent with the facility's best management practices <br /> • The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan <br /> D The facility employee's role with regard to spills and overfills as specified in the UST Response Plan <br /> ➢ Names of contact person(s)for emergencies and monitoring alarms.49,70 <br /> X. COMMENTS/ADDITIONAL INFORMATION <br /> Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.49 71 <br /> �>f PW OICJ Jrve- Avett—I q5 u <br /> XI.PERSONNEL RESPONSIBILMUS <br /> The UST Owner/Operator is responsible for ensuring that:1)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered by <br /> this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. <br /> The following person(s)are responsible for performing the monitoring and equipment maintenance. <br /> NAME 490.72 TITLE <br /> 490-n <br /> NAME 490-74 TITLE 490.75 <br /> The Designated Operator shall perform a monthly visual inspection of the facility, provide a report to the owner/operator,and inform the owner/operator of any <br /> conditions that need follow-up action. <br /> XII.OWNERIOPERATOR SIGNATURE <br /> CERTIFICATION:1 certify that the informatio o ' herein is true and accurate to the best of my knowledge. <br /> APPLICANT SIGNATURE �.- 49 76 DATE: n 490-77 <br /> // ` <br /> C._ ... <br /> ESENTIN I.Tank 8707 F wn r/0 emlor 3.AwhonzcJ Re resm�aiiv or wn <br /> APPLICANT NAME(print): 4111 A-PPLICA14T TITL 490-79 <br /> S n lel, G'l' <br /> UPCF UST-D(12/2007)3/4 <br />
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