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BILLING_2001-2015
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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PR0231300
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BILLING_2001-2015
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Last modified
10/13/2023 4:21:08 PM
Creation date
11/7/2018 11:13:29 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
2001-2015
RECORD_ID
PR0231300
PE
2361
FACILITY_ID
FA0001858
FACILITY_NAME
MY MINI MART
STREET_NUMBER
1756
Direction
N
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
APN
11721005
CURRENT_STATUS
01
SITE_LOCATION
1756 N WILSON WAY
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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\MIGRATIONS\W\WILSON\1756\PR0231300\BILLING 2001-2012.PDF
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EHD - Public
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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUNDSTORAGETANK <br /> MONITORING PLAN- (Page 2 of 2 <br /> eck <br /> VL UNDER DISPENSER CONTAINMENT(UDC)MONITORING Cat hap a' <br /> UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) <br /> ❑ 1.CONTINUOUS ELECTRONIC MONITORING ® 2.FLOAT AND CHAIN ASSEMBLY El 3. <br /> 3.ELECTRONIC STAND-ALONE 4965a <br /> ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) <br /> -..-- 49655. MODEL#: 49656. <br /> LEAK MONITOR MANUFACTURER: 49M7. 490-ss. <br /> S): <br /> LEAK SENSOR MANUFACTURER: MODEL#( 49659 <br /> DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. 11a.YES [Ib.NO <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ <br /> e.YES ❑ b.NO 49040' <br /> FAILURDDISCONNECTION OFUDC DC M0141TORLNG SYSTEM I'RIGGERS AUTOMATIC PUMP SI IUMOW N ❑ a.i'ES ❑ b.NO <br /> 4nn-6! <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. 13a.YES ❑ b.NO 490-62. <br /> 4966x. <br /> UDC CONSTRUCTION IS: ❑ 1.SINGLE WALL El2.DOUBLE WALL <br /> 49664x. <br /> IF DOUBLE WALL: <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM aAwto <br /> A LEAK Wt'1'HlN'rHE SECONDARY CONTAINMENT OFTHH UDC(RIGGERS AUDIBLE AND VISUAL ALARMS. L] a.YES ® b.NO <br /> VII. PERIODIC SYSTEM TESTING <br /> 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49665. <br /> LEAK DETECTION(ELD)MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS RE UIRED.123 cat§2644.11 49066 <br /> ® 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 4904 <br /> ® 3. SPILL BUCKETS ARE TESTED ANNUALLY. <br /> VIII. RECORD KEEPING <br /> The following monitoring/maintenance records are kept for this facility: 49o-6a. <br /> ® a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ® c.TANK INTEGRITY TESTING RESULTS <br /> ❑ d.SIR TESTING RESULTS tend supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) <br /> ❑ f ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS <br /> E h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS <br /> UL TRAINING <br /> Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties: 49049x. <br /> REFERENCE DOCUNIEN'I'S MA1N'1'AiNED AT FACILITY(Teck aii thar app/Y) <br /> ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 496696. <br /> ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 49669`' <br /> ® CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490 69d <br /> ® CALIFORNIA UNDERGROUND STORAGE TANK LAW x9069. <br /> ® STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 49669E <br /> STATISTICAL INVENTORY RECONCILIATION' 49669x. <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 4966914 <br /> ❑ OTHER(Specify): 490d9` <br /> This facility has-a-Designated UST Operator"who hes passed the California UST System Operator Exarn administered by the International Code Council 49610. <br /> (ICC). The "Designated UST Operator"will train facility employees in the proper operation and maintenance of the UST systems annually,and within 30 <br /> days of hire. this 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 /> D 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 facility's UST Response Plan. <br /> ➢ Name(s)of contact person(s)for emergencies and monitoring alarms. <br /> X. COMNIENTSiADDITIONAL INFORMATION <br /> Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan. 49611. <br /> Overfillprevention: Mechanical flow restrictor set at 95%of tank capacity <br /> XL PERSONNEL RESPONSIBILITIES <br /> The UST Owner:/Operator is_respmnsible for ensuring that: 1.)the 0m].3,/rotione i_Is i monitoring activities and maintenance of UST leak detectitm em.!ipment covered <br /> dtis plan ocem_s_2�all conditions tt!at indicate ap_ossible release are investigated;and 3.)all monitormg nords ere m_ainteinedpropecI ;___,______ <br /> THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: <br /> NAME: Ram Rattan 490-Ta TITLE:Operator Manager 690-73' <br /> NAME: 49614. TITLE: x9015. <br /> The Designated UST Operator shall perforin 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. OWNER/OPERATOR SIGNATURE <br /> CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> APPLICANT SIGNATTJRE n DATE: 4W77. <br /> APPLICANT <br /> 718/2009 <br /> REPRESENTING:Q 1.Ta&Owner/ br ❑2.Fffity Owam/ atm U 3.Autltori R aenla ve of Owaer 490-76. _ _ <br /> 4961x. APPLICANT TITLE: x9619. <br /> APPLICANT NAME(print): <br /> Ram Rattan Operator/Manager <br /> UPCF UST-D(1212007).3/4 www.uddoca.org <br />
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