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b]'9i U6i 2UJ3 C13: 29 T5460343- FIFTH :-LJLJQ - u- I1 UNDERGROUND STORAGE TANK MONITOR NG yPLAN—PAGE 2 i+lON170 PANEL MANUFC CTRONlC MON OiRING O h�RS. IrR'+7�0 O � �v HODIS)(Check all that apply; msa. ❑ I.CONTINUOUS LLE PCTURER: MODELA: asst. LGKSET150R MANUFAC'T RF.R s4' MODEL b(S):,_ J4L. WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND V ISUAL ALARh15'+ O A.YES ❑ b.NO WILL A UDC LBAK ALARM TRIGGER AUTOMATTC PUMP S'HCJTDOW'N7 ❑ a.YES ❑ b.NO ntse. WILL FAILURE/DISCONNBCTION OF UDC MONIr'OR[NG SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN'' ❑ a.yES ❑ b•NO msr. 2.MECHANICAL ASSEMBLY 1c.g.,FLOAT AND CHAIN ASSEMBLY)IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK ASSEMBLY MANUFACTURER: Msa MODEL#(S): btsa. ❑ 3.VISUAL MONITORING DONE: ❑ a.DAILY ❑ b.WEEKLY tacgmE:rgrgy uwro,all mw ❑ 4.NO DISPENSERS ❑ 99-OTHER(Specify) ME1 VIII' ENIi'1N�ED I:E'AICDE w ' � '� 'PE'C'FION ❑ I.WE HAV-BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD 7HAT WE MUST IMPLEMENT ENHAN•-ED LEAK •`"' DETECTION(ECA)FOR THE UST(S)COVERED BY THIS PLAN,PER 23 CCR§Z644.1,ELD 15 PERFORMED EVERY 36 MOn'-,11S AS REQUIRED {� TRAVMNG iL REFERENCE DOCUIvtENTS MA[M'AE.'L•D AT FACILITY(Check ell nkat apply) "iga I. ❑ 1`115 UNDERGROUND STORAGE TANK MONITORING PLAN(Required) L ❑ OPERATINGMANUALS FOR ELECTRONIC MONITORINGEQUIPMENT(Rcqulred) 3. ❑ THE FACILITY'S BEST MANAGI-:4 ENT PRACTICES(Required as of 7n/Z004) 4. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ❑ CALIPORNIA UNDERGROUND STORAGE TAKE:LAW 6. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION' "HANDBOOK FOR TANK OWNERS -MANUAL AND STATISTICAL rNWENTORY RECONCILIATION" 7. ❑ SWRCB PUBLICATION:"WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" 99.❑ OTHER(Specify): 1,181. Personnel with USTmunitwing responabilides are flmiliarwitlt all of the above documents relevant to theirjob duties and can°eters those document,when needed. By Jul 1.2oDd this£acidity will have a"Designmod UST Operatce who has pissed the operator exam mmimsomd by the ImemaHcnal Code Council(FCC). By Jud 1, 4, and ,aally thereafter,the "Designated UST Operator"will train facility employers:in the J Flt De ryproper operation and maintenance of the UST systems.This training will inchde,but is not limited ro,the£olluwinB: > Operation of Ate UST systems in a manner cens!stcnt with clic facility's best management practices. > The facility employoc's role with record to the leak detection equipment. > rhe lbelliey employee's role with rcgwd w spills and overllls. > Whom to wntacr fm C)Tgf eneies and JCak deteeV.Cn alarms. For facility employees hired M m atter July 1,2004,the initial training will be conducted within 30 days ofthe date of hiro I?i ;Go1TMENTS% D�►ITIOl*L'INF'OR"17ALTION Please use-h.ig secucn m lneludc any additional UST system tnOnitoring-related infmmatian(ag..addilioni:infom,anan required by W.local agency): Nes Es r a F 7/L2JW,THE"DESIGNATED UST OPERATOR" IDENTIFIED IlV SECTION lll(OFBTt�CURRL•N-f L'S I OPF,R,gTfNG PERMIT APPLICATION- FACILITY FORA WILL HAVE ULTIMATE 4LTHORITY FOR PERFORMING THE MONITORING ACT[VIT1ES AND MAINTAIN(NG LEAK DETECTION EQUIPMENT COVERED BY TI-IIS PLAN,AND WI-L PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL rN$PFCTIONS OF THE PACILIT' S LT. YSTCMS w ACCORDANCE R17H23 CCR d 2715(b1 XI. OWNEWOP.ERATOR SMNATILRE CERTIFICATION:I certify that the'iformation provided herein i5 true and accurate to the best ofmy knowledge. 0 OP rTOR SI'NATURL• PRBSFNT DATE: Owl. Owner Mw. i ❑Operator e� / i �y 3 OWNER/OPERATOR NAME(pnmk M°a OWNER'O.PERA Ok TITLE- Mgene),Use Only) This pion has been reviewed anal: ❑Approved ❑Approved Wiih Condinans ❑Disapproved Local Agency Signature: Date commenlespecial Conditions: `----- SJCTHD-d(07103)-314 07r:3/03