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VIED PROGRAM CONSOLIDATED FORM ad UNDERGROUND STORAGFTANK MONITORINGPLAN (Pagr2af2) _ VI.UNDER DISPENSER CONTAINMENT(UDC)_MONI_T_ORING a a 1. illi[MONI TURIN(:IS PERFORMED USING ITIE FOLLOWING METHOD aaaans ', �.t. 19 1 CYN tiNUOUs FLFCTRONICMOIv11(NtlNCi 02 FLOAT AND CHAIN ASSEMBLY ❑ 3 FLK'TRONIC ti1AND-AFONI }❑d NO DISPENSI•RS ❑99 Ol HF;R(_S�ctilg) _ I PANEL MANUFACTURER VEEPei? Roar- L4 __L}AK SENSOR MANUFACTURER r _ _ "1M(N)EL I(S_Y- _ ?9Y3SfA' � mew DETEYTION OF A LLAK INTO THE UDC TRIGGf Its AUDIBLE AND VISUAL ALARMS B a YI S ❑b NO UDC LEAK ALARM TRIGCFKS AIPt'CIMATK'PLIMPSHUIOOWN M a YES ❑b W) FAILUREfDISC'ONNECTK)N OF 11DC MONII GRIND SYSTEM IRK;GERS AUTOMATK'PUMP SHUTDOWN Ba YES 0 W) IJDC MONITORING S LOPS'IHt PLOW OF PRODUC-1 AT THE DISPENSER 3 a YES ❑b NO awex 2.0IX'CONSTRI C1 ION IS E41 SINCII-F-WAI T FD 112 OOIIBLE-WALLFD IF DOUBLE IYALLED: UDC INYM- n"ML SPACE IS MONITORED BY l LI ID 2 PRESSl1RE_Q 1 VACUUM - _- -... .... . A A i FAK WITHIN THE SFiCONDARY CONIAI_NMFNT OF THE UDC TRIGGERS AUDIBLE AND VLSUA1 ALARMS-❑a YLS_❑D NO j VII.PERIODIC SYSTEM TESTING -- -- ❑ BOARD 7HAf 1 EIA TESTING THIS F knit TV HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL. ES4NIIA[X'Fl) " ' LEAK DELL•1'IIIN/1LI,AjLU51 Bt PFRHNtMEUW11RED123CCR-2M41)tF � - �},Q'2 SiMlINPARY CUNT AINMKN F COMPUNEN I'S ARK T ES TER EVERY Ia MONTHS __ -__—D____---_— C33 5PIL1.BUCKETS__ARE TESTED ANNUAl•LY VIII.RECORDKEEPING _. 1T following monuormF/nramienam:e records cite kepi for this facility Alarm logs 49 ft ❑Visual l nspenuon Rfrurds 1%ab ❑lank integrity testing resuln+vo-rec 1 ❑SIR resting results(ail supponmg documentation records) ❑ lank gouging resuhs(and sappamng dacurncmauon rccnnl.T ria,es, j ❑AIG-Icamg results(and supporting documemanon Winds) +miuf ❑ ('ortosrtm Pmtrctim(dFday lags 4a 1 1 ❑Equipment mamlerante and calibration retards aan wn -- --� IX.TRAINING _ - _— �Persmael with US f mmaorng respmwbdnres we larmi ar with all ofde folbwngdrxome nl mk`n` t to than loTr dwra asae+a R RENCE DOCUMHN IN MAIN I AINE.D A EACHATY(Check all Nal apply) THIS UNDERGROUND STORAGE TANK MONI PORING PLAN(Requaed)n OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Requiredlasaeae ❑ CALIFORNIA UNDERGROUND STORAGF TANK RFGIN.-ATTONS araaaa ❑ CALIFORNIA UNDERGROUND 91'URAGE TANK LAW aware ❑ STArE WATER RESOURCES CONTROL_ IH-)ARD (SWRCB) PUBLICATION -HANDBOOK FOR LANK OWNI RS - MANUAI AND STA'ITSTICAL INVENTORY RECONCIITA'TION"awaw ❑SW RCB PUBLICATION "DNDERSfANDING AUTOMATIC TANK GAUGING SYSTEMS"~, D 01 HER(Specify) Mnsk MiVh - -- -#�+Ihn Ihcddy has u`Ucsngretrd 11ST OaraMr--'-who has passed de Cinrfnrna UST System Opemlor Cam admnnwercd try the intemauoead C+dr(buecd IIC'CI 'M`Dcs+graaed UST Operator"will train fwubly emPloyees in Ne Proper operation and mmmcaaace of the US r systems annually-and within 30 days of hire Ibis uammP wd4 include but is nor limned to the following Y Operation of the UST systems in a manner coosissenl with the facility's Deal management practices 'r The facility employee s role with regard to the mentioning equipment n specrhed in this UST Momlonng Plan w the faahty,empluyec's role wah rcgrad to spills and overfills as spa .Fwd m de UST Reponse Plan I r Names ofeoraact lersurgs)foremrrgencua<and monnonng alarms #)0 Is X- COMMENTS/ADDITIONAL INFORMATION Prow de additional wmmnrB Rina w utd mle haw nTony pages withmfonrm h additional am on specific morrmnng prwedwam,cs armached to N s plan am t XI.PERSONNEL RESPONSIBILITIES — the USr ommi pcmm m mWp ble for enarmg Ned U die doily!routim UST mortaring aelrait+ea wtd marraenaree of UST la4 detection egmpment covered M Ihw p4m ce .,2)dl a.odamrw than indicate a pacable release ata mveslugmed.and 3)all monitoring reronls are maintained properly he fNlowigg pusonts)aponsible far performing them nmnmmg and egmpment mamlenanee aas>s f NAME !1^ Uc rest�4 NAME aw-ta TITLE +arts The tleaW,,W upmmie shall perform a monthly vestal trispeewn of the facility.Pravda a ream Io The ownerloperatm•and mtbrrn the owtet!operalor or an) conditions thin need Rdlow-up action XII.OWNERIOPERATORSIGNATURE CERTH-1 A ONE I c a that the inforraatum tided Derain is true and accurate ro the F+rst oFmy know AP A Sl ATUR awte DATE / I � \- - -7 g, k n arrtar+mu.i+ Awhosizallawwwwwwoualglano aaa.A aao-n APPLICANT TITLF APPLR'ANI NAME(print) � � ` P� a e-r i A-) 1) F L, to CE USI-n Uan.Na7)ua