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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN— e 2 of 2 VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING (Chock au UDC MONITOR@IG IS PERFORMED USING THE FOLLOWING METHOD(S) that apply) ® I.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE d9 5- ❑ 4.NO DISPENSERS �}--❑ 9999.OTHER(Specify) 45a50,. LEAK MONITOR MANUFACTURER Y asass. MODEL#: 4W%. LEAK SENSOR MANUFACTURER: 4--< 4F/2 7208`T 4so57. MODEL#(S): 44o5e. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. 7i9(I.�Yfj.�wC �a.YES ❑ b.NO 49oss UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. 7 W[�a.YES ❑ b.NO 4W59 FAILURE1DISCONNECDON OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a a YES ❑ b.NO S UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER aa.YES ❑ b.NO 49Q� UDC CONSTRUCTION IS: ❑ 1.SINGLE WALL E.DOUBLE WALL 4 . IF DOUBLE WALL: UDC INTERSTITIAL SPACE IS MONITORED BY: B-a.LIQUID ❑ b.PRESSURE ❑ C.VACUUM 4 .4 A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. a.YES ❑ b.NO d� VII. PERIODIC SYSTEM TESTING 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED —s. L CTI N(ELD1 MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.ID ccn yzs44.p ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 4so es 0 3.SPILL BUCKETS ARE TESTED ANNUALLY. 4yo sr VIII. RECORD KEEPING The following monimring/maintConam records are kept for this facility: 49oaa ® a ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTSand supporting ppGdocumentation records) [3 f LOS ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS ® It EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following doct®eMs televam m themjob druies: 4sosa4. REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Checkall that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490-696 ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 49ob9c. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS - 49oru ❑CALIFORNIA UNDERGROUND STORAGE TANK LAW 41 a ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 49p69r STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490699 ❑ OTHER(Specify): 490696. 49p69i. This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 49 " (ICC). The "Designated UST Operator"will wain 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 facility's UST Response Plan. > Name(s)ofcontact:personas)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide ad itional comments here or indicate how many pages with additional information on specifi monitoring procedures are attached to this plan. 490.]1_ '7 0 Ar— �� W 401 XL PEICNIIJINNEL 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 this plan occurs all conditlons that irdicate a possible release are investigated;and 3. all monitoring records are maintained properly. THE FOLLOWING PERSONS)ARE RESPONSIBLE FOR PERFORMING THE MONITOREN A D EQUI MAINTENANCE: _- NAME: S - ^ 4 4wn. TITLE: �� 49 n NAME. 49at4. TITLE: 49075. 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 conditions that need follow-up action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify thatfiteivaqrmation provided herein is true and accurate to the best of My knowledge. APPLICANT SIGNATURE DATE: 496:n. REPRESENT : r.Tads ow F®li Owner/ I 3.Auap,imd iomutiveofOvmv 490.]6 'f � 9 . rl v APPLIC NAME(prim): {_ 490. ' APPLICANTTITLE: 490-79. �6L�K PLO,.['s ID�,17 UPCF UST-D(IM2007)-3/4 wws.aaidots.org