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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING m. 4W: 49a54b r_14RING IS PERFORMED USING THE FOLLOWING METHOD 3,ELECTRONIC STAND-ALONE US ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 4va66. SERS _..__......._..-- ......._.._.� - LEAK SENSOR MANUFACTURER: Ilq,�, Fsl� �a.YES ❑V.NO DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS Ga a YES ❑b.NO 490fi0. UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN49461 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SIiLTDOWN. oda YES [3 b.NO 49461 UDC MONITORING STOPS THE FLOW OF PRODUCT AT TELE DISPENSER a906J 2.UDC CONSTRUCTION IS ❑LSINGLE-WALLED $.2.DOUBLE-WALLED IF DOUBLE WALLED: --- - 690.y4y UDC INTERST[TEP.L SPACE IS MONITORED BY: I.LI UID_ 2.PRESS A LEAK WCTHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDB3LE AND VISUAL ALARMS a.YES [Ib.NO ❑ 1.ELD 7EST��G T FACII.ITY HAS BEEN NOTA DBS THV SKATE OAS INURCES CONTROL-BO D S 3 CCR� 11 —_ LEAK DETECTION(ELD)MUST BE PERFORMED PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQ_-__-_ ..--§'-644 ) 2.SECONDARY CONTAINMENT COMPONENT___-__-,__—_, .-.-- 3.SP[LL BUCKETS ARE TESTED ANNUALLY VIII.RECORDKEEPING iRThe following rranitorinP,/maintemnce records ate kept far this facility: Tank�� testis insults 4946xc �( Alarm logs 49 M Visual Inspection Records 4906xb Tank aunty resultgs(and supporting documentation records). 4W0 6& t]SIR testing results(and supporting documentation records). 4% gauging ❑ATG Testing results(and supporting documentation records).a946xf ❑ Corrosion Protection 60-day logs a946xg Equipment maintenance and calibration records. 4946xh U( TRAINING personnel with UST monitoringrespoasibilides are familiar with all of the following documents relevant to theirj°b duties. 4% �FERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) THIS UNDERGROUND STORAGE TANK MONTFORING PLAN(Required)49 9b O-ODERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)4v469: ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4WAJ ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW Is"% E] STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"49a69f ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"494 g ❑ OTHER(Specify):M6W1,169i tem _ This fac0ity has a"Designated UST Operator"who bas passed the Califomm TandCQ smaintenanceofthe US IDrysteems eaauaRynanit within 30 daysoof di chveI This The"Designated UST Operator"will train facility employees in the proper operation raining will include,but is not limited W.the fallowing: ➢ Operation of the UST ryslems in a manner consistent with the facility's best management practices ➢ The facility employee's role with regard b 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 UST Response Plan ➢ Namesofcontaciperson(s)finemm-9ma ieseadtaonitoringalarms.4WI0 X. COMMENTS/ADDITIONAL INFORMATION Provide additional comm is here or indicate how tinny pages with addmonal inf°rma[ieu on specific monitoring procedures are attacbed m this plan.494]1 /�GCH!}i�I HA2 L�IoI' qsy. XI.PERSONNEL RESPONSIBILITIES atme UST monitoring activities tdetection egaipmentcoveed by TheUSTs responsible frespngthae /et [ed, d 3)all monitoring records Are maintained property. an° Zteleasare mg The following Person(s)are responsible for performing the monitoring and equipment maintenance N 490-]J NAME 5I4lC,M- 49oar TITLE w'�R 490-,> NAME ,� 490-]4 TITLE Owl~ - The Designated Operator shall perform a monthly visas) inspection of the facility.provide a report to the owner/aperamr, and inform the ownerlopemtor of any conditions that need follow-up action. ^� XII.OWNER/OPERATOR SIGNATURE CERTIFI TION certify t the information provided herein is true and ccurate to the best of my knowledge. ova]] .t90-]6 DATE: APPLI IGN 494]9 F 494]x APPLICANT TITLE: APPLICANT NAME(print): S`N wN�' UPCF UST-D(12/20n3/4 ,,, L4wtA / rJor-1 — I ��