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NIFIED PROGRAM CONSOLIDATED FORM• UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of2) JUN - VI UNDER DISPENSER CONTAINMENT(UDC)MONITORING�� „��_,7CU�X 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD N� vI�E® LCONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-At, E -❑ 4_NO DISPENSERS___�99.0111ER(Specify):_________-____.__________________________._____a90=ss.1_________________._________-____.___.______-- 49o-s6. PANEL MANUFACTURER:VE_EDE_R ROOT _MODEL#:TLS-350 a9as] a9ass ___..LEAK SENSOR MANUFACTURER:RER:VEE EEDER ROOT__________.____.________.____________ _________.__________________________.______.___— MooEL w(s):794380-323 a.YES ❑h.NO ago-59 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ® aYES [I h.NO 4D0-W UDC .LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN 490-fit FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES a.YES El b.NO 49-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. 400 63 2.UDC CONSTRUCTION IS [ILSINGLE-WALLED ®2.DOUBLE-WALLED -- IFDOUBLE WALLED: __UDC INTERSTITIAL SPACE IS MONITORED BY__® L-LIQUID_- ❑_2_PRESSURE �3,VACUUM__------------_--------_---_._______________________. A LEAK WITHIN THF.SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ®a.YES ❑b.NO 90fi46 VII.PERIODIC SYSTEM TESTING ❑ I. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49-65. LFAK DETECTION(ELD)MUST BE PERFORMED. PERIODIC ELD 1S PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR§2644.1)_-_ ___ .. _ __.. _.-- --❑ _______ 490.66 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS, _ __ -_____- _-________ __ 490-67 ®3.SPILL BUCKETS ARE TESTED ANNUALLY. VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: ®Alarm logs 490-68a ❑Visual Inspection Records 490-68b ❑Tank integrity,testing results 490-6so 11SIR testing results(and supporting documentation records). 490-68d ❑ Tank gauging results(and supporting documentation records). 490-6ae ❑ATG Testing results(and supporting documentation records).490-68f ❑ Corrosion Protection 60-day logs 490-688 ®Equipment maintenance and calibration records. 49a6sh IX.TRAINING ®Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. 490-69a REFERENCE DOCUMENTS MAINTAINED AT FACILITY?(Check all that apply) M THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)4go-69b ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-69c ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49-69e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION”490-69f ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-691 ❑ OTHER(Specify):M69h.M69i ®This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(ICC). 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,the following: Y 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 UST Response Plan 'r Names of contact persons)for emergencies and monitoring alarms.490-70 X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.490-71 ( PAGE—SENSOR SUPPLEMENTAL FORM ATTACHED XI. PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that: 1)the daily/routine UST monitoring activities and maintenance of UST leak detec;theo"erloperator pment covered by this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The following pemon(s)are responsible for performing the monitoring and equipment maintenance. NAME DENNIS BOCK 490-72 TITLE COMPLIANCE MANAGER 490as NAME TIM HURLOCKER TITLE DIRECTOR OF GASOLINE OPERA The Designated Operator shall perform a monthly visual inspection of the facility, provide a report to the owner/operator, and inform of any conditions that need follow-upaction. XH.OWNER/OPERATOR SIGNATURE CERTIFICATION: 1 certify that the information provided herein is true and accurate to the best of my knowledge. 490 n APPLICANT SIGNATURE 490-76 DATE: /�v I ,l(yr G7/L(r / 2 REPRESENTIN ❑I Tank Owner10 ergror [12.Facilit Owner/O erabr_®r Authorized R resen ive of wner 490)9 490"79 APPLICANT TITLE: APPLICANT NAME(print): DENNIS BOCK COMPLIANCE MANAGER Belshire Environmental Services, Inc.