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- .KXIED PROGRAM CONSOLIDATED FORM ,w UNDERGROUND STORAGE TANK MONITORING PLAN (Piga 2 of 2) VI.UNDER DWEIMI .00NTAIIY�ENT(UDC MUN'ITORING I. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 49014a a90•s4b 0 1.CONTINUOUS ELECTRONIC MONITORING 112.FLOAT AND CHAIN ASSEMBLY ❑ 3.F_LFC~IRONIC STAND-ALONE 4,NO DISPENSERS ❑99.OTHER(Spa:i£y). PANEL MANUFACTURER:Veeder Root(VR) a9ass MODEL#:171,43-359R_ LEAK SENSOR MANUFACTURER:VR UDC interior V— 490-s7 MODEL#(S):7l43M209 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ® a YES ❑b.NO 494-b9 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a.YES ❑b.NO 490-d0. FAILURE I DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ©b.NO "o-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER ® a.YES ❑b.NO 490-62 2.UDC CONSTRUCTION IS ®1.SINGLE-WALLED ❑2.DOUBLE-WALLED 4 r IF DOUBL19 WALLED: ago est: UDC INTERSTITIAL SPACE IS MONITORED BY: ❑1.LIQUID ❑2.PRESSURE ❑3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑L YES ❑b.NO moo a+a VII:PERIODIC SYSTEM TESTING l;ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCEp 490-65- --I"DEF ,IQN j910 MUST BE PERFORMED. PERIODIC EM IS PERFORMED EVERY 36 MONTHS AS RE UIRED.(23 CCR J2644.1 ®2,SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 9-SPILL BUCKETS ARE TESTED ANNUALLY. -- ----__.... ___ .__-------_-- 49"1 VIIL'"CO"KEEPING Tbe fbilowing a lonitotinQ/nsairdensinee records are kept for this facility; S Alarm logs 49D."a C9 Visual Inspection Records 4W63b ❑Tank integrity testing results 490=6& ❑SIR tasting results(and supporting documentation records). 44U&d ❑ Tank gauging results(and supporting documentation records). 44a69e ❑ATG Testing results(and supporting documentation records).49o-of ❑ Corrosion Protection W-day logs 49o•3sg Equipment maintenance and calibration records. 49o•68b UL TRAINING Personnel with UST monitoring responsibilities are familiar with all of the Following documents relevant to their job duties, 490-690 REFERENCE DOCUMENTS MAINTAINED AT FACIEITY(Check all that apply) THIS UNDERGROUND STORAGE TAMC MONMORINOr PLAN(Required)4910 agb OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-49c CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4wod ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490-W ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-ft ❑ OTHER(Specify):w9n.w9i This facility has a"Designated UST Operator"who has passed the Califomis UST System Operator Exam administered by the International Code Council(ICC). The"Designated UST Operator"will train facility employem in the proper operation and maintenance of the UST systems annually,and within 30 days of hire.This training will include,but is not luted to,the following: > Operation of the UST systems in a maturer consistent with the facility's bast management practices i The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan i The:facility eanployee's role with regard to spills and overfills as specified in the UST Response Plant Names of oou=t person(s)for emergencies and monitoring alarms,490-70 X COMMENTSADDIMONAL INFORMATION Provide additional commews here or indicate how marry pages with additional information on specille monitorin procedures aro attached to this plan.ago-ri XL PERSONNEL RESPONSIBILITIES The UST Owner./Operator is responsible for ensuring that:1)the daily/routine UST trronitoring activities and maintenance of UST leak detection equipment covered by this plan occurs,2)all conditions that indicate a possible release are invtstigated,and 3)all monitoring records aro maintained pTvperly. The following persou(s)are responsible for performing the monitoring and equipment a®interu mcc, NAME 490.72 TITLE 490-73 NAME 49a74 TITLE 440-71 The Designated Operator shall perfonm a monthly visual inspection of the facility,provide a report to the owner/operittor.and inform the owneriopenator of any conditions that need follow-up action. XII.O'WNERIOPERATOR SIGNATURE CERTIFICATION:I certify_ that the information provided herein is true and accurate to the best of my know]edge. APPLICANT SIGNA 490.76 DATE: / 496,77 ago 71 APPLICANT NAME(print): APPLICANT TITLE: 496-79 Dennis Bock Compliance Manager UPCF UST-D(12/2007)3/4