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UNIFIED 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 490-54- e9-Sab ® I.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHER(Specify): PANEL MANUFACTURER:VEEDER ROOT 49x55 MODEL#:TLS-350 49-36. LEAK SENSOR MANUFACTURER:VEEDER ROOT 49-57 MODEL#(s):794380-208 49-sa DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ® a.YES ❑b.NO 49-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ® a.YES ❑b.NO 49060. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑b.NO °90"bt UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ® a.YES ❑b.NO 49-62 2.UDC CONSTRUCTION IS O L SINGLE-WALLED ❑2.DOUBLE-WALLED 49-63 IF DOUBLE WALLED: 49-6m UDC INTERSTITIAL SPACE S MONITORED BY: ❑1.LIQUID ❑2.PRESSURE ❑3 VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 49o-64b VII.PERIODIC SYSTEM TESTING Lj 1. ELD TESTING: THIS EACH= HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49-65, LEAK DETECT[ N MUST BE PERFORMED. PERIODIC EL,D IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR_§2644.1) ®2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49-66 3.SPILL BUCKETS ARE TESTED ANNUALLY. 89-67 VIIL RECORDKEEPING The following mormtoring/maintenmtce records are kept for this facility: ®Alarm logs 4s-sm ❑Visual Inspection Records 49-dsb ❑Tank integrity testing results 4WW ❑SIR testing results(and supporting documentation records). 49-68d ❑ Tank gauging results(and supporting documentation records). 49o-6ar ❑ATG Testing results(and supporting documentation records).49 mf ❑ Corrosion Protection 60-day logs 49-da1 ®Equipment maintenance and calibration records. 490-Uh IX.TRAINING ®Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. 49 &a REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)49 b ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)49-6x ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49-694 ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 4wo- ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION'49-d9r ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"49-691 ❑ OTHER(specify):moh.mms 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: ➢ 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.49 7o 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.49-71 XI.PERSONNEL 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 by this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The following person(s)are responsible for performing the monitoring and equipment maintenance: NAME DENNIS BOCK 490-72 TITLE COMPLIANCE MANAGER 49-73 NAME TIM IIURLOCKER TITLE DIRECTOR OF GASOLINE OPERATIONS The Designated 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 information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE 49-76 DATE: 'J 49-77 P ENTIN [32.F clic Owner rami ® . APPLICANT NAME(print): 490-78 APPLICANT TITLE: 490-79 DENNIS BOCK COMPLIANCE MANAGER Belshire Environmental Services,Inc.