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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 oft) VL UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD po-ser 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2-FLOAT AND CHAIN ASSEMBLY 090-sem a.NO DISPENSERS 99.OTHERS ❑ 3.ELECTRONIC STAND-ALONE PANEL MANUFACTURER—^ _--- ...._—,....__.—.. ...................__. M_:_ LEAK SENSOR MANUFACTURER: �� ,� __--'- aiMODPI. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ) 3 -ss UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a O &YES ❑b.NO °ro'p FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN e'YES ❑b.NO mos UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. a.YES O 6.NO 2 UDC COif$TRUCTION IS tet.SINGLE-WALLED e.YES ❑b.NO °9osz .Nat ❑2.DOUBLE-WALLED ayo,D IF DOUBLE WALLED: UDC INTERSTITIAL SPACE IS MONITORED BYE-fel,LIQUID _�PRESSURE �VACUUM °"° A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND RMS VISUAL ALA '"�,YES ❑b.NO Val.PERIODIC SYSTEM TESTING I. ELD TESTING: THIS FACILITY HAS BEEN NOTiF1E0 BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHA NCFD a9oac. DETFCt70N fF1�D1 MUST BE PERFORMED._PERIObIC ELD IS PERFORMED EVERY 36 MONTHS AS, E IJI .(27 CCR g260d,IL_m -SF.CONDARV CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 3.SPILL.ROCKETS ARE TESTED ANNUALLY. _---- —' .--•-_— _— ._490 49047 The fallowing monitonrtg/rtlaintenmTa records am kept for this(kcil'tyL RECORDKEEPING e Almm logs woes, (3Visual Inspection Records 490e41, SIR testing results and supporting ❑Tank igauging moltestt,nails posse ${ 8 ( Pponing documentation records). °9o.oed ❑ Tank gauging results(end slrQ ni ATG Testing msults land Supporting documentation records).Aw of C] Prptection bp.day l Corrosion P° ng dowmen(atioo records)_ wo6ss ags 4931.4EQuipment meintgtanee and calibration Cards. °9afilh IX.TRAINING JK parsomwl with UST monitoring maponsibilmes ere familiar with All of the following docmtrents relevant w theirjob duties, waear REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)JIOPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)49as9c 1:1CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONSEl CALIFweeps UNDERGROUND STORAGE TANK LAW 4". ❑ STATE OWIITER RESOURCES RES CONTROL BOARD (SW CB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"°9os9r ❑ SWRCB PUBLICATTON:'IMERSTANDING AUTOMATTC TANK GAUGING SYSTEMS",,"ca b ❑ OTHER(Specify):htasq Nara ff�This facility hes a"Desigtuted USi t pt It I who has passed the 1 11 Nf tnia UST System Operator Exam administered by the)ntettgtiortal Code Council(ICC)- The"Dpigutmad UST Operator"will train facility omployees in the proper operation and maimenance of me UST systema annually,and within C touring will include but Is not limited to,the following' days of hire.This > Operation of the UST systems in a manner consistent with the fociliry'S best to, practiws > 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 ov"Rlls as specified In the UST R I. Namara ofcartuct person(s)for emergencies and monog almms.°so->onito - esponsa Plan Provide additional commentX. COMMENTS/ADDITIONAL INFORMATION s here or indicate how many pages with additional information on spcci Tic matimring procedures are aetnched Ulis pl .aap-rt Orce�r�/t� bL. : A+r4'Ibdfsva a ►4k1 Q•~ S> � q 4� Xl.PERSONNEL RESPONSIBILITIES The UST Owrc,2)AB tvr is responsible for ensuring that: q the daily/routine UST monitoring activities and maintenance of UST Icak deTeation equipmem covered by Thu plan occurs,2)all conditiotn that indicate a possible release gra imesd The followi pn �and 3)dl monitoring records are maimained properly. AME /r(�' a Sasppnsiblc for pertormmg the monitoring end equipmem maim c /Y7�P •,'an TITLEy /Ff" //vCh hl�'r",� NAME (� w67e TITLE sso.n The Designated Operator shal perform a no thly visual i100 of the facility, provide a m %'i cwditions that need follow-up Action, to the owner/operator, and inform the owner/operator of airy X11.OWNER/OPERATOR SIGNATURE CERTIBICA ON:I certi that informatioll vided herein iS true and stet tato to the best of m tepowtedge- APPLICANTSI 'ATO wp)e DATE: 49.1 APPLICANT NAME(prinq: ., e9o.78 APP IJ CANT TITLE: uw-19 UPCF USTI(12/2007)3/4 rte''