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COMPLIANCE INFO 2001-2010
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231906
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COMPLIANCE INFO 2001-2010
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Last modified
9/8/2021 1:08:13 PM
Creation date
11/5/2018 3:42:20 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2001-2010
RECORD_ID
PR0231906
PE
2361
FACILITY_ID
FA0003776
FACILITY_NAME
KWIK SERV*
STREET_NUMBER
420
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06202042
CURRENT_STATUS
01
SITE_LOCATION
420 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\K\KETTLEMAN\420\PR0231906\COMPLIANCE INFO 2001-2010.PDF
QuestysFileName
COMPLIANCE INFO 2001-2010
QuestysRecordDate
5/19/2017 11:33:18 PM
QuestysRecordID
3391364
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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■ <br />10 <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />UNDERGROUND STORAGE TANK <br />MONITORING PLAN (Pare 2 of 2) <br />VL UNDER DISPENSER CONTAINMENT (UDC) MONITORING <br />1. UDC MON FORIN IS PERFORMED USING THE FOLLOWING METHOD was4. <br />1. CONTINUOUS-ECTRONIC MONITORING ❑ 2. FLOAT AND CHAIN ASSEMBLY 0 3. ELECTRONIC STA ND -ALONE wos4e <br />❑ 4. NO DISPENSERS ❑ 99 OTHERS i : <br />PANEL MANUFA RER: 890'ff MODEL _S snow <br />�...................... <br />o..4w vncn. �+ r ( wast MODEL N(S): - �Vsa(D�� <br />DETECTION OFA <br />EAK INTO 7HE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS '--- -"" n•o—fy <br />„g a. YES ❑ b. NO <br />UDC LEAK AL <br />TRIGGERS AUTOMATIC PUMP SHUTDOWN YES ❑ 6: NO °so'as <br />•j�;e. <br />FAILURE / DISCO NEC ION OF UDC MONITORING SY�MMTRIGGERS AUTOMATIC PUMP SHUTDOWN, JS a YES b. NO 49 1 <br />UDC MONITORIN <br />STOPS THE FLOW OF PRODUCT' ATDISPENSER. 181 YES O b NO .� <br />L UDC CONSTRUCII <br />NIS . SINGLE -WALLED ❑ 2. LE•WALLED was+ <br />IF DOUBLE WAL ED: - <br />UDC INTERSTIT <br />SPACE IS MONITORED BY: 1. L UID 2. PRESSURE 3. VACUUM wosoa <br />A LEAK WITHIN <br />SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a. YES ❑ b. NO_ °tae <br />VII. PERIODIC SYSTEM TESTING <br />7. ELD 'iF1"TING: <br />HIS FACILRY HAS BEEN NOi1FiED BY 'THESTATE W TER RESOURCE$; -CONTROL -BOfJtD THAT " +sass: <br />— <br />MUST BE PERFOR PERR)DN' ELD f5PBAFORA�EVERY36-VOWTHS AS .. IRED. (23 CCR IMP: . <br />. SECONDARYC <br />AWMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. .. wets <br />3. SPILL BUCKETS <br />RE TESTED ANNUALLY. — . <br />esss� <br />VIII-.RECORDKEEPIIVG <br />j7he following uaoito <br />recosycgrre.�kept�Enrthtjf>ra'Gty: t <br />Alarm hm wean+, <br />groats C.. <br />(3 VMWjhmp"�L„"T 4snsra ❑7adf tytratyng [taWtsawsac + ,. <br />,,. <br />s <br />A'Td aebng resdts ( <br />wY,4ga Pgq�are(:,acds). 4sowa.. [] Teak�iggr�l6(and 100hng 40F! l;ecorbM} 4soas. <br />pyotitn$-riowogelrtaCon feconls). +sate[ [uJ Cu40aoRPmOation 60-daylogs +saws <br />ipment main <br />and calibration records. 4%s <br />IR. TRAINING <br />turel. Wqh UST <br />ironing responsibilities are familiar with all of the following documents relevant a theirjob duties. 4so-e. ° _ <br />RENCE <br />NTS MAINTAINED AT FACU.ITy (Check ail that apply) <br />TATS <br />STORAGE TANK MONITORING PLAN (Rw*ed) 49 s% <br />..OPERATING <br />AIS FOR ELECTRONIC ))[O2$TC me EQUIPMENT.(Re+wvd)asaasa <br />CALtf'ORNIA <br />DERGROUND STORAGE TANK R£CULATfONS wossd <br />CALIFORA <br />DERGROUND STORAGE TANK LAW wow. <br />STATE WA'''RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL A:4 ) <br />STATISTICAL <br />VENTORY RECONCILIATK)N"4soasf <br />❑ Sm PVBLK: TK)N:"UNDERSTANDING AUTOMAT)CTANK GAUGING SYSTEMS"+sari, <br />13 OT (Specify): <br />alas, <br />This facifiry has a " <br />ignated UST Operator" who has passed the California UST System Opatator Exam administered by the i uW_ nal Coda Carr -0 (ICC). <br />Designated UST <br />include, <br />tor" win tram fadnity employees m the proper OPWAtioo and tnaimpianm Of the UST systems ammNI13, and within 30 days of vm. This <br />training will imited m, the following: <br />but[a) <br />Operation of the Utems <br />in a manner consistent with the facility's bas[ menagemant practices <br />D The fatality emploole <br />with regard to the monitoring equipment as specified in this UST Monitoring Plan <br />D The facility emplole <br />with regard to spills and ova�ils as specified in the UST Response Plan <br />D Names of contact <br />for emergencies and monitoring alarms. 4%-" <br />: <br />e <br />I .. <br />�:?moryM{yhwweUST aQ7lVtasi and napawtanc4ilf't?LTgnalr 4ieleaae egmpltatRIXd�lad iN <br />moords <br />M. <br />The Dmilitawd Operator <br />spection of the facility, provide a report to the owner/operator, and inform the ownerleprose v ofany <br />condivunc that roved folio <br />actien.. <br />OWNERADPERATOR SIGNATURE <br />CER3 aYfIAAi; i <br />>!se'" %Mill is truo4rlaO=aae b the best of ttt . <br />APPLICANT S A <br />r -". .. a 76 ..DATE: <br />- <br />APPLICANTNAME(priul> <br />APPLt ANTTITLE. wO' <br />UPCF USC -D (12CWY) 34 <br />ON mA. <br />hwt I <br />
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