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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN— (Page 2 of 2 VI. UNDER DISPENSER CONTAINMENT(UDC)MONITORING (chock all thatapply) UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ❑ I.CONTINUOUS ELECTRONIC MONITORING ® 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 4W$ft 491F5°E. ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) �......._.___ __ waw LEAK MONITOR MANUFACTURER:BraV0 49o-ss. MODEL#:BZ000 49o-s7. N(S): 49o-st LEAK SENSOR MANUFACTURER: MODEL DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES b.NO 4 59. UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ ..YES 151b.NO a9ow. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES '17 b.NO 440'6' a.YES ❑ b.NO 69 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER__ _ � _ _. _. _ ___ _...__..______.__ ..____..— UIX'CONSTRUCTION IS: 1.SINGLE WALL ❑ 2.DOUBLE WALL IF DOUBLE WALL: 490.544 UDC INTERSTITIAL.SPACE IS MONITORED BY: ❑ a LIQUID ❑ b.PRESSURE ❑ c.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO 090440. VII. PERIODIC SYSTEM TESTING 1.ELD TES'T'ING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490.65 LFTECTI E D MUST 8E PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. v CCR e2w4.1 ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. Q� ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490.67 VIII. RECORD KEEPING The following monitoring/maintenanoe records are kept for this facility: 49o-6s ® a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) ❑ f ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS ® h.EQUIPMENT MAINTENANCE.AND CALIBRATION RECORDS IX. TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties: 4 - RF.FERENCE DOCUMENTS MAIN'rAtNED AT FACILITY (Check all Thal apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) woa9b ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) a906x ❑CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-596 ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49°69`. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCS) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 490 ' STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 49o.69s. ❑ OTHER(Specify): 4� 490s9i 'rhis facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 4m-10 UCC). 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.(he following: Operation of the UST systems in a manner consistent with the facility's best management practices. r The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan. r The facility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. i Names)of contact person(s)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide itional corn is here or' dicate how many pa es h addition I'nformaC non pecifCQaniI / pmcCe �nah� pan. 0 71 I. PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for creating that: I.)the daily/routine UST monitoring activities and maintenance of UST k—A detection equipment covered _bythis pla occurs:2.)all conditions that indicate ap_jble release ase investigated',and 3.)all moniloring_2cords are roam fined properly. THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE M(INITORING AND EQUIPMENT MAINTENANCE.- NAME:: 7;e4 y1S 490-72 TITLE: �L�RM//✓A'L A'i✓A-«ie 490rr NAME: 490-74 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 that the info r r vid erein is true and accurate to the hest of m knowledge. APPLICANT SIGNATURE DATE: ��T-5y� °90x7 REPRESENTING.E31 1'mt O.,-0 AutSoriaW rcftngriR MOwnw 490.76. ✓ /Z—// APPLICANT NAME(print) 4 490.911 APPLI,CpANT ITLE: /J 490.79 CSO�c (, S �C N UPCF LIST-D(12/2007)-3/4 www.unidocxora