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COMPLIANCE INFO_2009-2014
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231331
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COMPLIANCE INFO_2009-2014
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Last modified
1/4/2021 1:20:05 PM
Creation date
6/3/2020 9:44:05 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2009-2014
RECORD_ID
PR0231331
PE
2351
FACILITY_ID
FA0000513
FACILITY_NAME
LODI MEMORIAL HOSPITAL
STREET_NUMBER
975
Direction
S
STREET_NAME
FAIRMONT
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
03107039
CURRENT_STATUS
01
SITE_LOCATION
975 S FAIRMONT AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\rtan
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\MIGRATIONS\UST\UST_2351_PR0231331_975 S FAIRMONT_2009-2014.tif
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EHD - Public
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UNIFIED PROGRAM CONSOLIDATED FOR11W. <br /> ;i UNDERGROUND STORAGE TANK <br /> MONITORING PLAN (Page 2 of 2) <br /> VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING <br /> 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54a <br /> 46 <br /> ❑ 1.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE <br /> ❑4.NO DISPENSERS ❑99.OTHER(Specify): <br /> PANEL MANUFACTURER: 49°55 MODEL#: 490-56. <br /> LEAK SENSOR MANUFACTURER 490.57 MODEL#(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 490.60 <br /> FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑b.NO 490-6I <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER ❑ a.YES ❑b.NO 490-62 <br /> 2.UDC CONSTRUCTION IS 111.SINGLE-WALLED ❑2.DOUBLE-WALLED 490-63 <br /> IF DOUBLE WALLED: 490.64a <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: 0 1.LIQUID 2.PRESSURE EJ 3.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 /> 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 2644.1 <br /> 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490.66 <br /> 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-67 <br /> VIII.RECORDKEEPING <br /> The following monitoring! tenance records are kept for this facility: <br /> 99 Alarm logs 49o.68a M Visual Inspection Records 490.686 IN Tank integrity testing results 49o-68c <br /> ❑SIR testing results(and supporting documentation records). 490-69d 0 Tank gauging results(and supporting documentation records). 490-68e <br /> ❑ATG Testing results(and supporting documentation records).49ofi8f ❑ Corrosion Protection 60-day logs 49o,68g <br /> Equipment maintenance and calibration records. 490-68h <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 apply) <br /> Q®� 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 490-69d <br /> CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-690 <br /> STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION"490-69f <br /> SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-69g <br /> ❑ OTHER(Specify):M69h,M69i <br /> 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 additio information on specific monitoring procedures are attached to this plan.490-71 <br /> Alarm sounds when tank is 90% full cz� o <br /> XI.PE ONNEL RtSPONSIBILLITIES <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 /> NAMERandy Roehrich 49042 TITLE Maintenance Su ervisor 490-73 <br /> NAME 490-74 TITLE 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.OV*NER/OPERATOR SIGNATURE <br /> CERTIFICATION:I cert at information provided herein is true and accurate to the best of my knowledge. <br /> APPLICANT SIGNAT ! or 490.76 DATE: 490-77 <br /> .� <br /> P I T - li or 3 orized Representative 7)t iv A <br /> APPLICA NAME(print): 490-78 APPL CANT TITLE: <br /> 490-79 <br /> UPCF UST-D(1212007)3/4 <br />
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