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I.. RECEIVED UNIFIED PROGRAM CONSOLIDATED FORM JAN ] j UNDERGROUND STORAGE TANK MONITORING PLAN — (Page 2 of 2) SAN JOAQUIN COUNTY VI. UNDER DISPENSER CONTAINMENT(UDC)MONITORINGHEALTH DEPA UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ❑ 1 CON INUOUS ELBCI"RONIC MONI'rORINO X 2.Pt.OA'IANDCHAINASSEMBLY ❑ 3 ELECrRONICsTAND-ALONL +"`•' ❑ 1.NO DISPENSERS ❑ 99.OTHERS _ LEAK MONITOR MANUFACTURER: +"'-S6 MODEL W: LEAK SENSOR MANUFACTURER: +"'"M7 MODEL H(S): +wsn DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES & b.NO UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES CK b.NO FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES X b.NO 41Mw'I UDC MONITORING STOPS THE FLOW OF PRODUCT A'T'THE DISPENSER. Ida. YES ❑ b.NO 4'Mw''- UDC CONSTRUCTION I.SINGLE WALL ❑ 2 DOUBLE WALL +1M113 IF DO IB L WA anu+a UDC INTERSTITIAL SPACE IS MONITORED BY. ❑ a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS, ❑ a.YES ❑ b.NO 4" b VII. PERIODIC SYSTEM TESTING 1 ELI) TESTING. THISFACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED +1M'115 LEAK D EL MUST BE PERFORMED, PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.133 CCR;Mu II ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. +•Mww ® 3 SPILL BUCKETS ARE TESTED ANNUALLY VIII. RECORD KEEPING The fbllownng monitoring/maintenance records are kept for this facility: +aua ® a ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c TANK INTEGRITY TESTING RESULTS ❑ d SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) ❑ f.ATG TESTING RESULTS(and supporting documentation records) ❑ g CORROSION PROTECTION 60-DAY LOGS h EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX" TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirlob duties +•M.e'n REFERENCE DOCUMENTS MA INl A INED AT FACILITY!Check all that opplo ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) w+ro ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULA"TONS ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW rnr.r'r ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: '-HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION "UNDERSTANDING AUTOMA"FIC TANK GAUGING SYSTEMS" " M ❑ OTHER(Specifv): 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 vain foci l it employees in the proper operation and maintenance of the US T 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 Mast 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 facility's UST Response Plan Namers)orcomact persons)for emergencies and monitoring alarms X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pa es with additional ' enation ons cite monitoring procedures are attached to this plan. 41"1-71 Iw 1 6K, `1S�e XI. PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that I.1 the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered by thoplan occurs.2 1 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 KO -F1/f'b6')(,Q +-M'.n TITLE: /�J7ZgOft AA"Ts;"— +,"•n NAME. 01.7+ TITLE: 14*gPxrT Su/GRVI 5.0� 411,75 The Designated UST 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. w I . WNER/OPERATOR SIGNATURE CERTIFICATION:t certify th t[h nfo a rovided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DA'IF,. 4'"07 REPRESENTING Ira,t.o�Mzrro rales cn.aa,o„x.no., sn�mue.cuR.,a.mm�,eoro••x.r +1101, 1-11-13 .-�- APPLICANT NAME(print)' 4'M'-78 APPLICANTTITLE: JF17i U PCF UST-D(12/2007)-3/4 www.unidces.org