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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 450-5 n Cit 1.CONTINUOUS ELECTRONIC MONITORING El 2.FLOAT AND CHAIN ASSEMBLY El 3.ELECTRONIC STAND-ALONE A ❑4.NO DISPENSERS ❑99.OTHER(Specify): PANEL MANUFACTURER:NUs9o-ss MODEL q: 'eva-ss. LEAK SENSOR MANUFACTURER: 4 S3 MODEL A(S): .g 4v 52 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS a.YES ❑b.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a.YES 11�.NO 49060_ FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑b.NO 490-61 DOC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. a.YES b.NO 490. 2.UDC CONSTRUCTION IS DRI.SINGLE-WALLED ❑2.DOUBLE-WALLED °9043 IF DOUBLE WALLED: 49o-w. UDC INTERSTITIAL SPACE IS MONITORED BY: [11.LIQUID_ El2_PRESSURE 03.VACUUM__ _ A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490'646 VII.PERIODIC SYSTEM TESTING ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 4%:95- ------ 90-6s_ ___ LEAK DETECTION(ELD)MUST BE PERFORMED, PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED,(23 CCR C3,2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490'66 5k3.SPILL BUCKETS ARE TESTED VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: ®.Alarm logs 49ocsa ❑Visual Inspection Records 490-69b ❑Tank integrity testing results 490.asc ❑SIR testing results(and supporting documentation records). 490-ii8d ❑ Tank gauging results(and supporting documentation records). 490-6se ❑ATG Testing results(and supporting documentation records).490.68r ❑ Corrosion Protection 60-day logs 490-68,, ®,Equipment maintenance and calibration records. 49o-e8n IX.TRAINING ®.Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. 49 69a REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) 59 TIES UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490596 ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490�9c [� CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490.69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 4906% ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION'490-69r ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-698 ❑ OTHER(Specify):M69b,M691 ,This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(ICC). 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 training will include,but is not limited to,the following: ➢ Operation of the UST systems in a manner consistent with the facility's best management practices ➢ The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan ➢ The facility employee's role with regard to spills and overfills as specified in the UST Response Plan ➢ Names of contact person(s)for emergencies and monitoring alarms.4m 70 X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.490.71 V/ $GL� XL PERSONNEL RESPONSIBILITIES 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 this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The follow n person(s)are res nsible for pertonning the monitoring and equipment maintenance: NAME 49oaz TITLE 490-73 NAME 490-r4 TITLEIF 490-75 The Designated Operator shall perform a monthly visual inspection of the facility, provide a report m the owner/operator, and inform the owner/operator of any conditions that need follow-up action. XII.OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SI(3p� 490-76 DATE: / 490-77 REPRESS TIN ❑ wr 02.F=hN0i0r10wmtor EAL3 AuthonzedReornisminveof0mucr V APPLICANT NAME(print: 490-°s APPLICANT TITLE: 490-39 L UPCF UST-D(122007)3/4