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• • 0 IMF UNIFIED PROGRAM CONSOLIDATED FORMWW UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING 1b 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490.54b �( 1. CONTINUOUS ELECTRONIC MONITORING ❑ 2. FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONE ❑ 4. NO DISPENSERS ❑ 99. OTHER (Specify): PANEL MANUFACTURER: a9ass MODEL #: / 49636. LEAK SENSOR MANUFACTURER 490's7 1 MODEL p(S): 7,7v L 51 3 490.38 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS Rka. YES ❑ b. NO 490." UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a. YES 4b. NO 490'60 FAILURE / DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a YES 2th. NO 490'61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER ❑ a. YES fib. NO 4W62 2. UDC CONSTRUCTION IS JQ L SINGLE -WALLED ❑ 2. DOUBLE -WALLED 493 IF DOUBLE WALLED: 690b°' UDC INTERSTITIAL SPACE IS MONITORED BY: 0 1. LIQUID Q 2. PRESSURE 3. VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a YES ❑ b. NO 4966ab VII. PERIODIC SYSTEM TESTING I. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 4�5- L DETECTION (ELDMUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1 . SECONDILARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490'66 3. SPL BUCIyTS ARE TESTED ANNUALLY. 4t VIII. RECORDYEEPING 77 F following monitoring/ imensnce records are kept for this facility: IR integrity $Alarm logs 49ad9a Visual Inspection Records 4a6rb Tank testing resuRs 4966aC testing results (and supporting documentation records). 4so.6sa RL Tank gauging results (and supporting documentation records). 49x6& ELSIR ATG Testing results (and supporting documentation records). 4a6ar ❑ Corrosion Protection 60 -day logs 4a6as ,Equipment maintenance and calibration records. 49060h DL TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documems relevant to theirjob duties. 49069a RERRENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) $, THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Requited) 490 % li PERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 49a69c CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 496694 CALIFORNIA UNDERGROUND STORAGE TANK LAW 4o69e STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"49049f Q�. SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 49 ss ❑ OTHER (Specify): M69k m6 This facility has a "Designated UST Operator" who has passed the Califomia 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 rtum¢r 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 ove�lls as specified in the UST Response Man L Names of commct person(s) for emergencies and monitoring alarms. 4so.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. 4671 XI. PERSONNEL RESPONSERILITIES The UST Owner/Operamr is responsible for ensuring that: 1) the daily/mutine 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 toll person(s) are responsible for performing the monitoring and equipment maintenance NAME Lei 4son TITLE zroes ggi 49691 NAME 49a74 TITLE 49675 The Designated Operator shall perform a monthly visual inspection of the facility, provide a report to the owner tut, and inform the owner/opemtor of any conditions that need follow-up action. XII. OWNEWOPERATOR SIGNATURE CERTIFICATION: I certify that the information provided herein is trite and aceumte to the best ofmy Imowledge. APPLICANT $ T[JRE 49at6 614— T DATE: Q 496n APPLICANT NAMF,-(print) /J 49679 APPLICANT TITLE: /' 49La79 Jy LiI/�7i v+Zr�eisT '✓4J) /& Com: f%//-l�-G/GJi/�- UPCF UST -D (122007) 314 it