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BILLING 2010 - 2015
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231233
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BILLING 2010 - 2015
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Last modified
12/4/2023 11:35:18 AM
Creation date
11/6/2018 10:26:14 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
2010 - 2015
RECORD_ID
PR0231233
PE
2361
FACILITY_ID
FA0002479
FACILITY_NAME
7-ELEVEN INC #17334
STREET_NUMBER
4501
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11017004
CURRENT_STATUS
01
SITE_LOCATION
4501 N PERSHING AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\P\PERSHING\4501\PR0231233\BILLING 2010 - 2015.PDF
QuestysFileName
BILLING 2010 - 2015
QuestysRecordDate
8/26/2016 5:17:24 PM
QuestysRecordID
3176652
QuestysRecordType
12
QuestysStateID
1
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EHD - Public
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.wOUNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN (Page 2 of 2) <br /> VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING <br /> 490-54a <br /> 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 49 546 <br /> ® 1.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE <br /> ❑4.NO DISPENSERS ❑99.OTHERS i <br /> PANEL MANUFACTURER: Veeder Root 49 55 MODEL#:TLS 350 490-56. <br /> LEAK SENSOR MANUFACTURER Veeder Root 4-50 MODEL#(S): 352 490.58 <br /> DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ® a.YES ❑b.NO 49 59 <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ® a.YES ❑b.NO 49040, <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 TBE DISPENSER ❑ a.YES ®b.NO 490fi2 <br /> 2.UDC CONSTRUCTION IS ®1.SINGLE-WALLED [12.DOUBLE-WALLED 490-63 <br /> IF DOUBLE WALLED: 490-64a <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ 1.LIQUID_[12.PRESSURE [13. <br /> VACUUM _ <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490-646 <br /> VII.PERIODIC SYSTEM TESTING <br /> I. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. <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 /> l�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 490-68a Z Visual Inspection Records 490-686 ❑Tank integrity testing results 490-68c <br /> ❑SIR testing results(and supporting documentation records). 490S8d ❑ Tank gauging results(and supporting documentation records). 4w,sse <br /> ❑ATG Testing results(and supporting documentation records).49068f ❑ Corrosion Protection 60-day logs 490-68g <br /> ®Equipment maintenance and calibration records. 490-a8h <br /> IX.TRAINING <br /> ®Personnel with UST monitoring responsibilities are familiar withal]of the following documents relevant to their job duties. 490-6% <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) <br /> ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-696 <br /> ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-69c <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490494 <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 4% 9e <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION"49 W <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490 s9g <br /> ❑ OTHER(Specify):M6%,MA <br /> -19 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 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 /> ➢ Names of contact person(s)for emergencies and monitoring alarms.490-70 <br /> X. COMMENTS/ADDITIONAL 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 /> Overfill prevention is mechanical flappers set at 95%of tank capacities <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(s)are responsible for performing the monitoring and equipment maintenance: <br /> NAME CHAUHAN,HANESHINDER&PUSHPINDER 490-72 TITLE Franchisee 49o-73 <br /> NAME Deanne Rom 490-74 TITLE Regional Gasoline Environmental Compliance Spec 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.OWNERIOPERATOR SIGNATURE <br /> CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> APPLICANT SIGNATURE ^ 490-76 DATE: 4 -00 <br /> 7/27/2012 <br /> 8 T 2 F iii a/0 erator 03 A ry i Re resenradve o[Oxmer <br /> APPLICANT NAME(print): 490-08 APPLICANT TITLE: 4 79 <br /> Stephen Boyd for 7-Eleven Regional Gasoline Env. Compliance Mgr. <br /> UPCF UST-D(12/2007)3/4 <br />
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