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COMPLIANCE INFO_2009-2015
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2300 - Underground Storage Tank Program
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PR0231320
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COMPLIANCE INFO_2009-2015
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Last modified
11/8/2022 2:49:25 PM
Creation date
6/23/2020 6:46:48 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2009-2015
RECORD_ID
PR0231320
PE
2361
FACILITY_ID
FA0003602
FACILITY_NAME
TESORO (SPEEDWAY) 68151
STREET_NUMBER
35
Direction
N
STREET_NAME
CHEROKEE
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04318003
CURRENT_STATUS
01
SITE_LOCATION
35 N CHEROKEE LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
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\MIGRATIONS\UST\UST_2361_PR0231320_35 N CHEROKEE_2009-2015.tif
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EHD - Public
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J-5-my Var U.1y/ !$`Approvea U Approved With Conditions LJ Disapproved <br /> Local Agency Signature: ;glow-Ii!T D* �4 <br /> Comments or Special Conditions: <br /> UPCF 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 approvalp1ior to installing or modifying monitoring equipment. (Note: Numbering of these instructions follows the data element numbers on <br /> the form.) <br /> 490-54a. MONITORING OF THE UNDER DISPENSER CONTAINMENT-Indicate the method used for UDC monitoring. <br /> 490-54b. SPECIFY-If 99"Other"is checked,describe other method used. <br /> IfVl-J-I,VI-1-2 or VI-1-3 or VI-1-99 is checked,complete 490-55 to 491 <br /> 490-55. PANEL MANUFACTURER-Enter the name of the manufacturer of the monitoring system control panel(console). If there is no control panel(e.g.,only an electrical <br /> relay box is installed)leave this space blank. <br /> 490-56. MODEL#-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 space blank. <br /> 490-57. LEAK SENSOR MANUFACTURER-Enter the name of the manufacturer of the sensor(s). <br /> 490-58. MODEL#(S)-Enter the model number of the sensor(s)installed.If additional space is needed,use Section X. <br /> 490-59, DETECTION OF A 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. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN-Indicate Yes or No. <br /> 490-62. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER-Indicate Yes or No. <br /> 490-63. UDC CONSTRUCTION-Indicate if the construction of the UDC is single-walled,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 CONTAINMENT OF UDC TRIGGERS AUDIBLE AND VISUAL ALARMS-Indicate Yes or No. <br /> 490-65. V11-1 ELD TESTING-Check the box if you have been notified by the State Water Resources Control Board(SWRCB)that the UST(s)covered by this plan is/are <br /> subject to Enhanced Leak Detection Requirements(i.e.,LIST has any single-wall component and is located within 1,000 feet I public drinking water well). <br /> 490-66. TESTING OF SECONDARY CONTAINMENT COMPONENTS EVERY 36 MONTHS-Check the box if you have secondary containment that requires testing, <br /> 490-67. SPILL BUCKET TESTING-Check the box ifyou havespill buckets. <br /> 490-68, VIII RECORDKEEPING-Indicate which monitoring and equipment maintenance records are 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. Note that the <br /> first two items on the list must be kept at the facility. <br /> 490-69b. MONITORING PLAN:Indicate that this plan is kept as 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 LIST REGULATIONS-Indicate that this is kept as a reference document. <br /> 490-69e. CA UST LAW-Indicate that this is kept as a reference document. <br /> 490-69f.ST ATE WATER RESOURCES CONTROL BOARD(SWRCB)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 /> 490-69h.OTHER-Indicate that other reference documents are kept. <br /> 490-69i. SPECIFY-If"OTHER"is checked,enter a brief description of the other documents)maintained at the facility.If additional space is needed,see Section X. <br /> 490-70. DESIGNATED OPERATOR TRAINING-Check this box to verify that this statement is true. <br /> 490-71, COMMENTS/ADDITIONAL INFORMATION-Make additional comments or you may attach and identify the number of additional pages of information to describe <br /> any additional UST system monitoring-related information(e.g.,additional information required by your local agency). Attach any monitoring logs that you will be <br /> using for the monitoring of your tank system <br /> 490-72. NAME-Enter the name of the person who routinely conducts the monitoring and equipment maintenance under this plan. <br /> 490-73. TITLE-Enter the title of the person. <br /> 490-74. NAME-Enter the name of the second person,if applicable,who routinely conducts the monitoring and equipment maintenance under this plan. <br /> 490-75. TITLE-Enter the title of the second person. <br /> OWNER/OPERATOR SIGNATURE-The tank ownerloperator,facility owner/operator,or an authorized representative of the owner shall sign in the space provided. <br /> This signature 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 implemented. <br /> 490-76. REPRESENTING- Check the appropriate box to indicate whether the signer is the LIST owner/operator, the LIST facility owner/operator, or an authorized <br /> representative of the owner. <br /> 490-77. DATE-Enter the date the plan was signed. <br /> 490-78. APPLICANT NAME-Print or type the name of the person signing the plan. <br /> 490-79, APPLICANT TITLE-Enter the title of the person signing the plan. <br /> UPCF UST-D(12/2007)-515 www.unidocs.org <br /> IN <br />
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