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Underground Storage Tank Monitorin,Ian-Page 2 of 2 <br /> t VL DISPENSER MONITORING Mso <br /> MONTIORING OF AREAS BENEATH DISPENSER(S)IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) <br /> ® 1.CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT(UDC) Msa. <br /> PANEL MANUFACTURER: Veeder Root MSI. MODEL N: oetj'TL S SO Msa <br /> LEAK SENSOR MANUFACTURER: Veeder Root _ M61. MODEL k(S): 208 <br /> WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? n a.ES ® b.NO M" <br /> WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? Y Mst. <br /> WILL FAILURE/DISCONNECTION OF(IDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? R a.ES ® b.NO <br /> ❑ 2.MECHANICAL ASSEMBLY(e.g.,FLOAT AND CHAIN ASSEMBLY)IN UDC TRIPS SHEAR SALVE IN CASE OF LEAK Mw <br /> ASSEMBLY MANUFACTURER: , MODEL#(S): <br /> M6a <br /> ❑ 3.VISUAL MONITORING DONE: ❑ a.DAILY ❑ b.WEEKLY(aegahss agency wpmm) <br /> ❑ 4.NO DISPENSERS M61. <br /> ❑ 99.OTHER(Specify) <br /> VII. ENHANCED LEAK DETECTION <br /> M 0 <br /> ❑ 1.WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK <br /> DETECTION(ELD)FOR THE UST(S)COVERED BY TIES PLAN.PER 23 CCR§2644.1,ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED <br /> VHL TRAINING <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) Mgo. <br /> 1. N THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) <br /> 2. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) <br /> 3. ® THE FACILITY'S BEST MANAGEMENT PRACTICES(Required as of January 1,2005) <br /> 4. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS <br /> 5. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW <br /> 6. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION" <br /> 7. ❑ SWRCB PUBLICATION:"WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" <br /> MBI <br /> 99.❑ OTHER(Specify): <br /> Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and con access <br /> those documents when needed. <br /> By January I, 2005,this facility will have a"Designated UST Operator"who has passed the California UST Sytem Operator Exam administered by the International <br /> Code Council(ICC). By July 1,2005, and annually thereafter,the "Designated UST Operator"will train facility employees in the proper operation and maintenance <br /> of the UST systems.This mining 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 employce's role with regard to the leak detection equipment. <br /> ➢ The facility employee's role with regard to spills and overfills. <br /> • Whom to contact for emergencies and leak detection alarms. <br /> For facility employees hired on or after July 1,2005,the initial training will be conducted within 30 days of the date of hire. <br /> IX. COMMENTS/ADDITIONAL INFORMATION <br /> Please use this section to include any additional UST system monitoring-related information(e.g,additional information required by your local agency): Mss. <br /> Note regarding Section X.Pending certification of a Designated UST Operator,the following person has authority for performing the monitoring <br /> activities and maintaining leak detection equipment covered by this plan. NAME: JOB TITLE: <br /> Name. Karem Singh Job Title. Operator <br /> Contact: Office: 209.834.1220 / Cell: 209.814.8581 / Home. 209.832.7810 <br /> X. PERSONNEL RESPONSIBILITIES <br /> AS OF JANUARY 1, 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT <br /> APPLICATION— FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING <br /> LEAK DETECTION EQUIPMENT COVERED BY THIS PLAN,AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS <br /> OF THE FACILITY'S UST SYSTEMS IN ACCORDANCE WITH 23 CCR§2715(b). <br /> XL OWNER/OPERATOR SIGNATURE <br /> CERTIFICATION: I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> OWNER/OPE TOR SIGNATURE REPRESENTING DATE: Mgt <br /> ❑owner M O ' p� O <br /> ROperator O� <br /> OWN PERATOR NAME(print): M92' OWNER/OPERATOR TITLE: <br /> V� e!t ,� <br /> (Agency Use Only) This <br /> `plan <br /> vhas been reviewed and: Approved ❑Approved With Conditions ❑Disap'pmvcd <br /> Local Agency Signature:k N r '`r� Date: <br /> Con mentstspecial Conditions: <br />