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2300 - Underground Storage Tank Program
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PR0231706
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BILLING_PRE 2019
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Entry Properties
Last modified
10/5/2022 3:50:41 PM
Creation date
4/2/2019 11:05:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
PRE 2019
RECORD_ID
PR0231706
PE
2361
FACILITY_ID
FA0000485
FACILITY_NAME
FLAG CITY CHEVRON
STREET_NUMBER
6421
STREET_NAME
CAPITOL
STREET_TYPE
AVE
City
LODI
Zip
95242
APN
05532024
CURRENT_STATUS
01
SITE_LOCATION
6421 CAPITOL AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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KBlackwell
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EHD - Public
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D PROGRAM CONSOLIDATED FOMF <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN-(Page 2 of 2 <br /> VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING (Cmt apply) <br /> heck all <br /> UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) <br /> ® 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54a. <br /> ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) 490-54b' <br /> LEAK MONlToR MANUFACTURER:Veeder Root 490-ss. MODEL#:TLS 350 490-56. <br /> LEAK SENSOR MANUFACTURER:Veeder Root 4911-57. MODEL#(S):794380-304 490-59. <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 49-60. <br /> FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a YES ❑ b.NO 49-61. <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ® a.YES ❑ b.NO 490-62- <br /> UDC CONSTRUCTION IS: ® 1.SINGLE WALL ❑ 2.DOUBLE WALL 490.63. <br /> IF DOUBLE WALL: 490.64& <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: ® a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ® a YES ❑ b.NO 49"0, <br /> VII. PERIODIC SYSTEM TESTING <br /> 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490.65• <br /> LEAK DETECTION LD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.[23 CCR§2644.11 <br /> ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS_ 490.66. <br /> ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-67. <br /> VIII. RECORD KEEPING <br /> The following monitoring/maintenance records are kept for this facility: 490-68. <br /> ® a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS E c.TANK INTEGRITY TESTING RESULTS <br /> ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) <br /> ❑ f.ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS <br /> ® h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS <br /> IX. TRAINING <br /> Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: 490-69& <br /> REFERENCE DOCUMENT'S MAINTAINED AT FACILITY(Check all that apply) <br /> ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 49-6%. <br /> ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490-69c. <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d. <br /> ® CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e. <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 49-69f: <br /> STATISTICAL INVENTORY RECONCILIATION" <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490-69s. <br /> ❑ OTHER(Specify): 490-69i. <br /> This facility has a"Designated UST Operator"who has passed the Califomia UST System Operator Exam administered by the International Code Council 4w70- <br /> (ICC). The "Designated UST Operator"will train facility employees in the proper operation and maintenance of the UST systems annually,and within 30 <br /> days of hire.This 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 /> ➢ The facility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. <br /> ➢ Name(s)of contact person(s)for emergencies and monitoring alarms. <br /> X. COMMENTS/ADDITIONAL INFORMATION <br /> I'rovr additional comments here dicate how many es with additional information on specific monitorin procedures are attached to this plan. 490-71 <br /> +0, Pry r a �E over ►1 ,�y e `ova <br /> XI. PERSONNEL RESPONSIBILITIES <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 <br /> by 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: Haleh Amin 49-72. TITLE:Owner 49-73. <br /> NAME: Kumam Khajevandi 490-74. TTTI-,E:Manager 490-75. <br /> The Designated UST 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. OWNER/OPERATOR SIGNATURE <br /> CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> 121�LA7 <br /> DATE: ^ �/O av��-'7 <br /> owrer/ ❑2.Each Owner or I3 3.Authorized Rqxesentwye of Owner 490-76. (�I <br /> r <br /> ICANTNAME(print): 490-79. APPLICANT 490-79 <br /> r(WaL,5 <br /> UPCF UST-D(122007)-213 www.unidocs.org <br />
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