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BILLING 2007 - 2015
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0232507
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BILLING 2007 - 2015
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Entry Properties
Last modified
10/26/2023 2:23:14 PM
Creation date
11/6/2018 11:33:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
2007 - 2015
RECORD_ID
PR0232507
PE
2361
FACILITY_ID
FA0003846
FACILITY_NAME
Verizon Business: LDIKCA
STREET_NUMBER
2500
Direction
W
STREET_NAME
TURNER
STREET_TYPE
Rd
City
Lodi
Zip
95242
APN
029-030-39
CURRENT_STATUS
01
SITE_LOCATION
2500 W Turner Rd
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\T\TURNER\2500\PR0232507\BILLING 2007 - 2015 .PDF
QuestysFileName
BILLING 2007 - 2015
QuestysRecordDate
9/8/2016 6:06:18 PM
QuestysRecordID
3186027
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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(Agency Use Oily) This plan has been t ed ad: pproved ❑Approved With Conditions 7 <br /> Local Agency Signature:ctalCo / YSI �_ Dale: , <br /> Comments or Special Conditions: <br /> i <br /> UST Monitoring Plan—Page 2 Instructions <br /> Complete a separate UST Monitoring Plan for each UST monitoring system at the facility. This form must be submitted with your initial UST <br /> Operating Permit Application and within 30 days of changes in the information it contains. Please note that your local agency may require you to <br /> obtain approval prior to installing or modifying monitoring equipment. (Note: Numbering of these instructions follows the data element numbers on <br /> the form.) <br /> 490-54s.MONITORING OF THE UNDER DISPENSER CONTAINMENT-ladicate the method used for UDC monitoring. <br /> 490-54b.SPECIFY-If 99"Other'is chocked,describe other method used. <br /> If V 1-1-1,V I.1.2 or VI-1-3 or V 1-t-99 is chocked,complete 490-55 to 490-64b. <br /> 490-55. PANEL MANUFACTURER-Enter the name of the manufacturer of the monitoring system control panel(console). If them ism control panel(e.g.,only an electrical <br /> relay box is installed)leave this space blank. <br /> 490.56. MODEL 9- Enter the model number for the monitoring system control panel(console).If there is no control panel(e.g.,only an electrical relay box is installed)leave <br /> this <br /> space blank. <br /> 490-57. LEAK SENSOR MANUFACTURER-Enter the name of the manufacture of the sensor(s). <br /> 490-58. MODELM(S) Fate the model number of the sensors)installed.If additional space is needed,use Section X. <br /> 490-59. DETECTION OFA LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. Indicate Yes or No <br /> 490-60. UDC LEAK ALARM TRIGGERS PUMP SHUTDOWN- Indicate Yes or No <br /> 490-61. FAILUREIDISCONNEC ION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN-Indicate Yes or No <br /> 490-62. UDC MONITORING STOPSTHE FLAW OF PRODUCT AT THE DISPENSER-Indicate Yes or No. <br /> 490-63. UDCCONSTRUCTION- Indicate if the construction of the UDC is singlewalled,or double-walled <br /> 490-64a.DOUBLE-WALLED INTERSTITIAL SPACE MONITORING- Indicate what is used to monitor the interstitial space. <br /> 490-64b.LEAK WITHIN THE SECONDARY CONTAMENT OF UDC TRIGGERS AUDIBLE AND VISUAL ALARMS-Indicate Yes or No <br /> 490-65. VII-1 ELD TESTING-Cheek the box ifyou have been notified by the Stale Water Resources Control Board(SWRCB)that the UST(s)covered by this plan is/are <br /> subject to Enhanced Leak Detection Requirements(i.e.,UST has any single-wail component and is located within 1,000 fen ofa public drinking water well). <br /> 490.66. TESTING OF SECONDARY CONTAINMENT COMPONENTS EVERY 36MONTHS-Check the box ifyou have secondarycontainmet that requires(eating. <br /> 49067. SPILL BUCKET TESTING-Check the box ifyou have spill buckets. <br /> 49068a-h.V 111 RECORDKEEPING-Indicate which monitoring and equipment maintenance records arc maintained for this facility. <br /> 490-69a IX TRAINING STATEMENT-Check the box to verify that the statement is true. <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY Check the appropriate boxes to describe reference documents maintained at the facility. Nae that the <br /> first two items on the list must be kept at the facility. <br /> 490696. MONITORING PIAN:Indicate that this pep is kept m a reference document. <br /> 490-69c OPERATING MANUALS FOR ELECTRONIC EQUIPMENT:Indicate that this plan is kept as a reference document. <br /> 490-69d. CA UST REGULATIONS-Indicate this this is kept as a reference document. <br /> 490-69e CA UST LAW-Indicate that this is kept as a reference document. <br /> 49069(.STATE WATER RESOURCES CONTROL BOARD(SW RCB)PUBLICATION- `HANDBOOK FOR TANK OWNERS-MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION-Indicate that this is kept as a reference document. <br /> 490.69g.SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS":Indicate that this is kept as a reference document. <br /> 49069h.OTHER-Indicate that other reference documents are kept. <br /> 49069i. SPECIFY-if-OTHER"is checked,enter a briefdescriptwn ofthe other documents)maintained at the facility.If additional space is needed,see Section X. <br /> 490-70. DESIGNATED OPERATORTRAINING-Check this box to verify that this statement is true. <br /> 490-71. COMMENTSIADDITIONAL INFORMATION-Make additional comments or you may attach and identify the number Dfadditional pages ofinforrtation to describe <br /> any additional UST system monaming-related information(e.g.,additional information required by your Inial agency). Attach any monitoring logs that you will be using <br /> for the monitoring of your tank system. <br /> 490.72. NAME-Enter the name ofthe person who routinely conducts the monitoring and equipment maintenance under this plan. <br /> 490-73. TITLE- Enter the title ofthe person. <br /> 490-74. NAME-Enter the name ofthe second person,ifapplicable,who mulinelyconducts the monimnng and equipment maintenance under(his plan. <br /> 490-75. TITLE- Enter the title ofthe second person. <br /> OWNEIVOPERATOR SIGNATURE-The tank owner/operator,facility owner/opemlor,or an authorized representative ofthe owner shall sign in the space provided <br /> This signal"certifies that the signer believes that all information submitted is true,accurate,and complete,and that the training program specified in Section IX has <br /> been implememed. <br /> 490-76. REPRESENTING--Check the appropriate box to indicate whether the signer is the UST owner/operator,the UST facility owneloperntor,or an <br /> authorized representative ofthe owner. <br /> 490-77. DATE:-Enter the date the plan was signed. <br /> 490-78. APPLICANT NAME-Print or type the name ofthe person signing the plan. <br /> 490-79. APPLICANT TITLE-Enter the title ofthe person signing the plan. <br /> t-nl .-1 rx,r 1/1.1,1/1 <br />
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