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BILLING_PRE 2019
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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PR0231948
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BILLING_PRE 2019
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Last modified
1/18/2022 3:44:53 PM
Creation date
4/29/2019 11:24:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
PRE 2019
RECORD_ID
PR0231948
PE
2361
FACILITY_ID
FA0003855
FACILITY_NAME
TESORO (SHELL) 68153
STREET_NUMBER
2448
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
05814001
CURRENT_STATUS
01
SITE_LOCATION
2448 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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i <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUNDSTORAGETANK <br /> MONITORING PLAN —(Page 2 of 2) <br /> ll <br /> VI. UNDER DISPENSER CONTAINMENT(UDC) MONITORING (Check <br /> that apply) <br /> UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) <br /> ❑ 1.CONTINUOUS ELECTRONIC MONITORING ® 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54a <br /> ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) 490_54b <br /> LEAK MONITOR MANUFACTURER: 490.55 MODEL H: 490-se <br /> LEAK SENSOR MANUFACTURER: 490.57 MODEL H(S): 490-58 <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 4900 <br /> FAILURElDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ® b.NO 49x61 <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ® a.YES ❑ b.NO 490.62 <br /> ..-.. —. <br /> UDC CONSTRUCTION IS. ® I. i SINGLE WALL ❑ �.DOUBLE WALL .490.63 <br /> IF DOUBLE WALL: 490-64a <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO 490-641' <br /> VII. PERIODIC SYSTEM TESTING <br /> 1. 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 i <br /> ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490.66- <br /> ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490.67 <br /> VIII. RECORD KEEPING <br /> The following monitoring/maintenance records are kept for this facility: 490-68 <br /> ® a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS <br /> ❑ d.SIR TESTING RESULTS(and 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 /> ® h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS <br /> IX. TRAINING <br /> Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: 490-69a <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that appl)) <br /> ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 49049b <br /> ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490.690 <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490.69d <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69C <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: -HANDBOOK FOR TANK OWNERS - MANUAL AND 490.69E <br /> STATISTICAL INVENTORY RECONCILIATION" <br /> ElSWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490-69g <br /> 490 490.6491 <br /> ❑ OTHER(Specify): 91 <br /> This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 490-70 <br /> ([CC). 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 /> > The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan. <br /> D 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. COMMENTS/ADDITIONAL INFORMATION <br /> Provide additional comments here or indicate how many paees with additional information on specific monitoring procedures are attached to this plan. 490.71 <br /> Overfill Protection= mechanical flapper 95% <br /> XI. PERSONNEL RESPONSIBILITIES <br /> The UST Owner/Operator is responsible for ensuring that. I.)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered <br /> by this plan occurs;2.Zall conditions that indicate at�3ssible release are investigated;and 3.)all monitoring records are maintained pro y_ <br /> THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: <br /> NAME: Roberta Metcalf 490-7'- TITLE:Manager 490.71 <br /> NAME: Sandy Edwards 490-74 TITLE:Environmental Compliance Administrator 490.7 <br /> The Designated UST 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. OWNER/OPERATOR SIGNATURE <br /> CERTIFICATION:1 certify that the information provided herein is true and accurate to the best of my knowledge. <br /> APPLICANT SIGNATU I DATE: 490-77 <br /> 6/30/2010 <br /> REPRESENTING ®1 Tank lhvner/0 atm 2. acilnv Owner! o�or❑l..\utlwrized R uative orOw 490-76 _ .. ___ - <br /> Lf PCF UST-D(12/2007)-4/7 www.unidocs.org <br />
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