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COMPLIANCE INFO 2004 - 2011
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231098
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COMPLIANCE INFO 2004 - 2011
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Last modified
7/25/2019 8:52:05 AM
Creation date
7/24/2019 4:44:08 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2004 - 2011
RECORD_ID
PR0231098
PE
2361
FACILITY_ID
FA0003830
FACILITY_NAME
VILLAGE WEST MARINA
STREET_NUMBER
6649
STREET_NAME
EMBARCADERO
STREET_TYPE
DR
City
STOCKTON
Zip
95219
APN
09815006
CURRENT_STATUS
01
SITE_LOCATION
6649 EMBARCADERO DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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'010 07:15A FROM: TO:12094683433 P.2 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN (Page 2 of 2) <br /> Vt.UNDER DISPENSER CONTAINMENT(UDC)MONITORING <br /> -` 490.544 <br /> 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 49044b <br /> ❑ 1,CONTINUOUS ELECTRONIC MONITORING 'X2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELEC'T'RONIC STAND-ALONE <br /> ❑4.NO DISPENSERS ❑99.0THER S i <br /> 490-55 <br /> PANEL MANUFACTURER: MODET.#: 490.56. <br /> ---- --------------------•___•.. ...------------- <br /> LEAK SENSOR MANUFACTURER: 490'57 1 MODEL#(S): 490-58 <br /> DE'T'ECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES t4b.NO 490-59 <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES Pb.NO 490.60. <br /> FAILURE I 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 490.62 <br /> 2.UDC CONSTRUCTION IS 1%1.SINGLE-WALLED ❑2.DOUBLE-WALLED 490-0 <br /> IF DOUBLE WALLED: 490-64& <br /> UDC INTERSTITIAL SPACE IS MONITORED.BY:_OL—LIQUID ❑2.PRESSURE ❑3.VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a-YES ❑b.NO 490'", <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(ELDI MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR§2644.1) -- <br /> $12.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS <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 490.68& Visual Inspection Records 490686 ❑Tank integrity testing results 490-68e <br /> ]SIR testing results(and supporting documentation recards)_ 49e.68d ❑ Tank gauging results(and supporting documentation records). 490.680 <br /> ❑ATG Testing results(and supporting documentation records) 490.68f ❑ Corrosion Protection 60-day logs 490689 <br /> Equipment maintenance and calibration records. 49M81i <br /> IX.TRAINING <br /> Personnel with US'r monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 49069& <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) <br /> THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490.69b <br /> OPERATING MANUALS FOR ELEC'T'RONIC MONITORING EQUIPMENT(Required)490690 <br /> CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49o-m <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490.690 <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> S'T'ATISTICAL TNVENTORY RECONCILIATION"49OW <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490.699 <br /> ❑ OTHER(Specify):M69h M69i <br /> This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(ICC). <br /> The"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 trot limited to,the following: <br /> A 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 to 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.49o-7o <br /> X. COMMENTS/ADDITIONAL INFORMATION <br /> Provide additional comments here or indicate how marry pages with additional information on specific monitoring procedures are attached to this plHn 490.71 <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 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( are res nsibl��performing the monitoring and equipment maintenance <br /> NAME /-� 490-'2 TI-I LE ago-77 <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.OWNER/OPERATOR SIGNATURE <br /> CERTIFICATION:I certify that the inform 'on provided herein is true and accurate to the best ofmy knowledge. <br /> 490-77 <br /> APPLICANT SIGNATURE 490-76 DA'I S: <br /> 440-711APPLICANTTITLE490.79 <br /> APPLICANT NAME( rint): <br /> >bJc. '5,.,� t Zy,2r" W�...,.•i' �•,jiY7r.4.-4-'�`�1 /T�— <br /> 1 <br /> urcF UST-D(12f2007)3ra ,��� �/Jlb A(/'o r � —y <br />
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