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Underground Storage Tank Monitori*an—Page 2 of 2 • VI. DISPENSER MONITORING MONITORING OF AREAS BENEATH DISPENSER(S)IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) M50. E 1.CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT(UDC) PANEL MANUFACTURER:Veeder-Root M51, MODEL#:IU50 Mss. LEAK SENSOR MANUFACTURER:Veeder-Root MSa. MODEL#(S): Float &Chane M54. WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ❑ a.YES ❑ b.NO M55. WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M56, WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M57. ❑ 2.MECHANICAL ASSEMBLY(e.g.,FLOAT AND CHAIN ASSEMBLY)IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK ASSEMBLY MANUFACTURER: M58. MODEL#(S): M59. ® 3.VISUAL MONITORING DONE: E a.DAILY ❑ b.WEEKLY(it,.u.agency eppmvap M60. ❑ 4.NO DISPENSERS E 99.OTHER(Specify) MM. VII. ENHANCED LEAK DETECTION ❑ I.WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK M70, DETECTION(ELD)FOR THE UST(S)COVERED BY THIS PLAN.PER 23 CCR§2644.1,ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED VIII. TRAINING REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) MHO. 1. E THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 2. E OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 3. E THE FACILITY'S BEST MANAGEMENT PRACTICES(Required as of January 1,2005) 4. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 6. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 7. ❑ S W RCB PUBLICATION:"WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" 99. ❑ OTHER(Specify): Ma', Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to theirjob duties and can access those documents when needed. By January 1,2005,this facility will have a"Designated UST Operator"who has passed the California UST Sytem Operator Exam administered by the International Code Council(ICC). By July 1,2005,and annually thereafter,the "Designated UST Operator"will train facility employees in the proper operation and maintenance of the UST systems.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 leak detection equipment. ➢ The facility employee's role with regard to spills and overfills. D Whom to contact for emergencies and leak detection alarms. For facility employees hired on or after July 1,2005,the initial training will be conducted within 30 days of the date of hire. IX. COMMENTS/ADDITIONAL INFORMATION Please use this section to include any additional UST system monitoring-related information(e.g,additional information required by your local agency): Mss. Note regarding Section X. Pending certification of a Designated UST Operator,the following person has authority for performing the monitoring activities and maintaining leak detection equipment covered by this plan. NAME: JOB TITLE: X. PERSONNEL RESPONSIBILITIES AS OF JANUARY 1, 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT APPLICATION—FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIPMENT COVERED BY THIS PLAN, AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S UST SYSTEMS IN ACCORDANCE WITH 23 CCR§2715(b). XI. OWNER/OPERATOR SIGNATURE CERTIFICATION: I certify that the information provided herein is true and accurate to the best of my knowledge. OWNER/OPERATOR SIGNAVJRE REPRESENTING DATE: M91. p E Owner mw. --- ❑Operator December 17, 2007 OWNER/OPERATOR NAME(print): M92. OWNER/OPERATOR TITLE: M93. Paul Chevalier Maintenance Manager (Agency Use Only) This plan has been reviewed and: Lynpproved ❑Approved With Conditions ❑Disapproved Local Agency Signature: Date: ) 116 10 Comments/Special Conditions: UN-022A-3/5 www.unidocs.org Rev.10/14/03 it