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COMPLIANCE INFO_2012-2018
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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88 (STATE ROUTE 88)
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14971
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2300 - Underground Storage Tank Program
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PR0231911
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COMPLIANCE INFO_2012-2018
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Last modified
11/20/2024 9:21:33 AM
Creation date
6/23/2020 6:53:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2012-2018
RECORD_ID
PR0231911
PE
2361
FACILITY_ID
FA0000540
FACILITY_NAME
COUNTRYSIDE LIQUORS & GAS
STREET_NUMBER
14971
Direction
N
STREET_NAME
STATE ROUTE 88
City
LODI
Zip
95240
APN
06316025
CURRENT_STATUS
01
SITE_LOCATION
14971 N HWY 88
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\rtan
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FilePath
\MIGRATIONS\UST\UST_2361_PR0231911_14971 N HWY 88_2012-2018.tif
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EHD - Public
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1NIFIED PROGRAM CONSOLIDATED FORD <br /> UNDERGROUND STORAGE TANK ` <br /> MONITORING PLAN (Page 2 of 2) 0 <br /> .UNDER DISPENSER CONTAINMENT(UDQ O G <br /> UDC MONITORING IS PERFORMED4990-5USING THE FOLLOWING METHOD 40-54464 <br /> I.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE <br /> ❑4.NO DISPENSERS C]99.OTHER(Specify): <br /> --_ --- --------------- <br /> PANEL MANUFACTURER: We 490-55 MODEL#: 7Z 490-56. <br /> LEAK SENSOR MANUFACTURER: F _ 490-57 t MODEL#(S): > 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 490-60- <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. XaraAW Pab.NO 49"2 <br /> 2.UDC CONSTRUCTION IS I.SINGLE-WALLED ❑2.DOUBLE-WALLED 490-63 <br /> IF DOUBLE WALLED: 490-64a <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: ❑1.LIQUID ❑2.PRESSURE ❑3.VACUUM _ <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490-64b <br /> VII.PERIODIC SYSTEM TESTING <br /> L ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED —5- <br /> LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1) <br /> 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 <br /> 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-67 <br /> RECORDKEEPING <br /> The following monitoring/maintenance records are kept for this facility: <br /> El Alarm logs 490-684 0 Visual Inspection Records 490.686 ❑Tank integrity testing results 49o-6k <br /> ❑SIR testing results(and supporting documentation records). 490.69d ❑ Tank gauging results(and supporting documentation records). 490-6se <br /> ❑ATG Testing results(and supporting documentation records).490-6sf ❑ Corrosion Protection 60-day logs 4w-6sg <br /> Equipment maintenance and calibration records. 490-68h <br /> UL TRAINING <br /> Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490.69a <br /> 'DEFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) <br /> THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-69b <br /> OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-699 <br /> CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS a <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION"490-69f <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"49o-69g <br /> ❑ OTHER(Specify):M69h,M6a <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 /> 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 /> • The facility employee's role with regard to spills and overfills as specified in the UST Response Plan <br /> 9 Names of contact person(s)for emergencies and monitoring alarms.490-7o <br /> X. COMMENTS/ADDITTONAL INFORMATION <br /> Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.490-71 <br /> .PASONNEL RESPONSIBUMUS <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 pe on(s)are responsible for performing the monitoring and equipment maintenance; <br /> NAME ;r° 490-72 TITLE ` 11 >® 490-73 <br /> NAME 41,02,C41490-74 TITLE 490-75 <br /> The Designated Operator shall perform a monthly visual inspection of the facility, provide a rWWto the owner/operator,and inform the owner/operator off any <br /> conditions that need follow-up action. <br /> XI[I.OWNER/OPERATOR SI A <br /> ,ERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> ?PLICANT SIGNATURE 490-76 DATE: 490-77 <br /> 41-11711v <br /> dVG" rank / rates 13 2.faqb Own a Q3.Agftozed Lteffesentatiycafer <br /> APPLICANT NAME(print): // 478 APPLICANT TITLE: 490.79 <br /> l <br /> UPCF UST-D(1212007)3/4 AM 3 4 2012 <br />
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