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IFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 49654 49x54 ® 1.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STANDALONE ❑4.NO DISPENSERS ❑99.OTHER(Specify): PANEL MANUFACTURER Veeder Bear(VR) 496ss MODEL#:TLS-3SOR 4W56' LEAK SENSOR MANUFACTURER VR UDC Interstitial&VR UDC interior 49657 1 MODEL#(S):112&323 4W5e DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ® a.YES ❑b.NO 49659 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ® a.YES ❑b.NO 49660. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑b.NO 490'61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER ® a.YES [3b.NO 4.662 2.UDC CONSTRUCTION IS ❑I.SINGLE-WALLED 02.DOUBLE:WALLED 490'65 IF DOUBLE WALLED: 490'64• UDC INTERSTITIAL SPACE IS MONITORED BY: ®1.LIQUID ❑2.PRESSURE Q 3.VACUUM _ A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ®a YES ❑b.NO 49°64b VII.PERIODIC SYSTEM TESTING 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49665. _LFaR DETECTION 6ELD1 MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1 ❑2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS, 49046 3.SPILL BUCKETS ARE TESTED ANNUALLY. 49"7 VI-IL RECORDKEEPING The following mcaitorinP/maintetance records are kept for this facility: ®Alarm logs 49oc82 ®Visual Inspection Records 496696 ❑Tank integrity testing results 49oss4 ❑SIR testing results(and supporting documentation records). 49 68d ❑ Tank gauging results(and supporting documentation words). 4966se ❑ATG Testing results(and supporting doerm5enation words).49668f ❑ Cnrmaien Protection 60-day logs 49oasg ®Equipment maintenance and calibration records. 496686 DL TRAINING ®Personnel with UST monitoring responsibilities are liuniliar with all of the following documents relevant to theirjob duties. 49oe94 REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)496696 ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Requited)46694 ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49om ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 4". ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCD.IATION'49 s9f ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490a, ❑ OTHER(Spccify):bw9r,w9i —EFIfacility has a"Designated UST Operator'who has passed the California UST System Operator Exam administered by the International Code Council(]CC). The"Desigrated UST Operator"will train facility employees in the proper operation and m7int4mance of the UST systems annually,and within 30 days of him.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 UST Response Plan • Names of contact person(s)for emergencies and monitoring alarms.49670 X, COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional mformmtioa wific monitoring procedure aro attached to this plan.49671 AL2 ;N4vK1 /7AYr /3i?tt =�o.I* ✓�lc/t A^'o ✓iaitStc oi.gt ALXwAf AT ;7%, XI.PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that: I)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered by this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring words are maintained property. The following persou(s)are responsible for performing the monitoring and equipment maintenance: NAME 496n TITLE 49673 NAME 49674 TITLE 49675 The Designated Operator shall perform a r mthly visual inspection of the facility,provide a report to the owner/operator, and inform the owner/operator of my conditions that need follow-up action. XIL OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNANRE__ _`-'—„ 49676 DATE: +9o-77 Sept.3,2009 APPLICANT NAME(prim): 490-� APPLICANT TrTLE. 490'. Dennis Bock Compliance Manager UPCF UST-D(12/2007)314