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COMPLIANCE INFO_1988-2004
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2300 - Underground Storage Tank Program
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PR0232355
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COMPLIANCE INFO_1988-2004
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Last modified
11/4/2022 10:12:50 AM
Creation date
6/23/2020 6:55:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1988-2004
RECORD_ID
PR0232355
PE
2361
FACILITY_ID
FA0000591
FACILITY_NAME
QUIK STOP MARKET #2152
STREET_NUMBER
1721
Direction
S
STREET_NAME
CHEROKEE
STREET_TYPE
LN
City
LODI
Zip
95240
APN
062-060-48
CURRENT_STATUS
01
SITE_LOCATION
1721 S CHEROKEE LN # 1
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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\MIGRATIONS\UST\UST_2361_PR0232355_1721 S CHEROKEE_1988-2004.tif
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EHD - Public
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�IFIED PROGRAM CONSOLIDATED FOR10 CJ I;/ TANK: TA0235501 <br /> !✓ PR#: PR0232355 <br /> FAC#: FA0000591 <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> VI.PIPING CONSTRUCTION(Check all that apply) Page 3 of 7 <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 9'1.PRESSURE ❑ 2.SUCTION ❑ 3.GRAVITY 458 ❑ 1.PRESSURE ❑ 2.SUCTION ❑ 3.GRAVITY _459 <br /> CONSTRUCTION ,❑L SINGLE WALL [-13.LINED TRENCH ❑ 99.OTHER 460 [:1I.SINGLE WALL ❑ 95.UNKNOWN 462 <br /> O 2.DOUBLE WALL E:195.UNKNOWN ❑ 2.DOUBLE WALL ❑ 99.OTHER <br /> MANUFACTURER 0 .S,,,t; 461 MANUFACTURER 463 <br /> ❑ 1.BARE STEEL 56.FRP COMPATIBLE w/100%METHANOL ❑ 1.BARE STEEL ❑ 6.FRP COMPATIBLE w/100%METHANOL <br /> ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL ❑ 2.STAINLESS STEEL ❑ 7.GALVANIZED STEEL <br /> ❑ PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN ❑ PLASTIC COMPATIBLE W/CONTENTS ❑ 95.UNKNOWN <br /> ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE(HDPE) ❑ 99.OTHER ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE(HDPE) ❑ 99.OTHER <br /> ❑ 5.STEEL W/COATING ❑ 9.CATHODIC PROTECTION 464 ❑ 5.STEEL W/COATING ❑ 9.CATHODIC PROTECTION <br /> 465 <br /> VIL PIPING LEAK DETECTION(Check all that apply)(A description of the monitoring program shall be submitted to the local agency.) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF ❑ 1.ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF <br /> FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION+AUDIBLE AND <br /> VISUAL ALARMS. VISUAL ALARMS. <br /> ❑ 2.MONTHLY 0.2 GPH TEST ❑ 2.MONTHLY 0.2 GPH TEST <br /> ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ❑ 3.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ❑ 4.DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> ❑ 5.DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIEAL PIPING ❑ 5.DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> INTEGRITY TEST(0.1 GPH) ❑ 6.TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS(NO VALUES IN BELOW GROUNDPIPING): <br /> ❑ 7.SELF MONITORING <br /> ❑ 7.SELF MONITORING <br /> GRAVITY FLOW <br /> ❑ 9.BIENNIAL INTEGRITY TEST(0.1)GPH GRAVITY FLOW(Check all that apply): <br /> ❑ 8.DAILY VISUAL MONITORING <br /> ❑ 9.BIENNIAL INTEGRITY TEST(0.1)GPH <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10.CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check one) ALARMS AND(Check one) <br /> ❑�/a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑ a.AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> LI7 b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM E] b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> r�❑ c.NO AUTO PUMP SHUT OFF ❑ c. NO AUTO PUMP SHUT OFF <br /> LT 11.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT OFF OR ❑ 11,AUTOMATIC LEAK DETECTOR <br /> RESTRICTION <br /> Z11 ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 12.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 13.CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' ❑ 14.CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW ❑ 15.AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITHOUT FLOW <br /> SHUT OFF OR RESTRICTION SHUT OFF OR RESTRICTION <br /> ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) ❑ 16.ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ❑ 17.DAILY VISUAL CHECK ❑ 17.DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 1.FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 4.DAILY VISUAL CHECK <br /> DATE INSTALLED 468 ❑ 2 CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑ 5.TRENCH LINER/MONITORING <br /> ❑ 3.CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ❑ 6.NONE <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS 469 <br /> IX.OWNER/OPERATOR SIGNATURE <br /> 1 certify that the information provided herein is true and accurate to the b of my knowledge. <br /> SIGNATURE OF OWNER/OPERATOR/ / DATE 7 _f!.� 470 <br /> NAME OF OWNER/OPERATOR(print) / TITLE OF OWNER/OPE TORO / <br /> kms' .�rY=L I t Yl:1c Sir, iy/As x' Tta71 HLech'2 C �4:✓;.�Ca7r�f an <br /> Permit Number(For local use only) 473 Permit Approved(For local use only) 474 Permit Expiration Date(For local use only) 475 <br /> PT0000596 EE0000646 6/30/2003 <br /> UPCF(12/99 revised) <br />
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