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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN- (Page 2 of 2) <br /> VI.UNDER DISPENSER CONTAINMENT (UDC)MONITORING (Check all <br /> that apply) <br /> UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) <br /> ❑ 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54a <br /> 4.NO DISPENSERS ❑ 99_OTHER(Specify) 490-54b. <br /> LEAK MONITOR MANUFACTURER: 490-55. MODEL 4: 49°'56- <br /> LEAK SENSOR MANUFACTURER: 490.57. MODEL#(S): 490-5s. <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 49060. <br /> FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 4906'. <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ❑ a YES ❑ b.NO 49062. <br /> UDC CONSTRUCTION IS: ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL 490-63. <br /> IF DOUBLE WALL: 49064. <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO 490-641,. <br /> VII. PERIODIC SYSTEM TESTING <br /> ❑ 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49065. <br /> LEAKDETECTION E D MUST BE PERFORMED. PERIODIC£LD IS PERFORMED EVERY 36 MONTHSAS .[n CCapf,14 iI <br /> E 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490- <br /> E 3,SPILL BUCKETS ARE TESTED ANNUALLY. 09061 <br /> VIII. RECORD KEEPING <br /> The following monitming/maintenance records are kept for this facility: 490-68. <br /> E a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS <br /> ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) <br /> ❑ f.ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS <br /> E h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS <br /> IX. TRAINING <br /> E Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. 490-69. <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) <br /> E OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT _- <br /> Q (Required) 490fi9c. <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49o-69d <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e. <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 49069f. <br /> STATISTICAL INVENTORY RECONCILIATION" <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490.69,. <br /> ❑ OTHER(Specify): 490-691,. <br /> 490.69 <br /> E This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 49040. <br /> (ICC). The "Designated UST Operator"will train facility employees in the proper operation and maintenance of the UST systems annually,and within 30 <br /> days of hire.This 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 /> D The facility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. <br /> ➢ Name(s)of contact person(s)for emergencies and monitoring alarms. <br /> X. COMMENTS/ADDITIONAL INFORMATION <br /> &Zid diti nal corn ants here or indicate how many pages with a Tonal information on specific monitoring procur s are attached to[his plan. 090.1. <br /> o 7 a � L <br /> XI. PERSONNVLREqPnNSIBILITIES <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 <br /> by this plan occurs;2. all conditions that indicate a possible release are investigated;and 3.)all monitoring records are maintained properly. <br /> NAME: tArn11 490-12. TITLE: �1i1/r Tt4', r/b.S Ir 490-13. <br /> NAME: . V 49,14. TITLE: 49x15. <br /> 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 <br /> conditions that need follow-up action. <br /> XII.;OWNER/OPERATOR SIGNATURE <br /> CERTIFICATION:I certify that i rmation provide a in is true and accurate to the best of my knowled g <br /> APPLICANT SIGNATURE yDATE: 11 /'� 4900-. <br /> aEYRESEM :❑1.Trak Ownerl areror Fecili owacd erator 3.Au ssd mmufisaf0 er 490-16. j\4v - VV <br /> APPLICANT E(print): n ^ n 490-1a APPLICANT TITLE: 49o-19. <br /> IM, <br /> UPCF UST-D(12/2007)-3/4 www.unidocs.org <br />