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UNIFIED PROGRAM CONSOLIDATED.FORM UNDERGROUND STORAGE T.,ANK JIONITORING PLAN (Page 2 of 2) VI. UNDER DISPENSER C07NT.AMMENT(UDC)110NITORENG ECONSTR ONITORING IS PERFORMED USING THE FOLLOWING METHOD TINUOUS ELECTRONIC MONITORING 0-90-54, ❑2.FLOAT AND CHAIN ❑ 3 ELECTRONIC STAND-ALONF a90"54b ISPENSERS ❑9 THER(S ecLA)MANUFACTURER: 490-56 ENSOR MANUFACTURER: tiIODELtl(S): "`- -"' i9ase TION OF A LEAK INTO THEUDC TRIGGERS AUDIBLEAND VISUALALAR4ISEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a YES ❑ b NO 090.59 E/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOtiiM a YES 0b NO 09060. ONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ❑ a YES ❑b.NO i90 61 a.YES ❑b.NO 090.62 STRUCTION fS ❑I.SINGLE-WALLED ❑2.DOUBLE-WALLED 190-63 IF DOUBLE WALLED: UDC INTERSTITIAL SPACE IS MONITORED BY: L LI UID 2.PRESSURE_ 3.V.ACUUNI 490-64a A LEAK WITHIN THE SECONDARY CONTAINMENT 0OFF THE UDCTRIGGERS AUDIBLE AND VISUAL ALARMS ---"- ❑a.YES ❑b.NO yo f++b VII.PERIODIC SYSTEM TESTING ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES COTITROL BOARD THAT ENHANCED 090 65 LEAK DETECTION(ELD)NiUST BE PERFORMED. PERIODIC El )IS PERFOR,tifED_EVERY3_6MONTHS AS RE UIRED. 23 CCR �6a t.i 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 N10N"THS. 5--��- - ❑3.SPILL BUCKETS.ARE TESTED AYNUALLY. —�-`— — -----_ +9066 090.61 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility Alarm logs 4906aa Visual Inspection Records 090-63b Tank integrity testing results 490.6ec SIR testing results(ani sLpporting documentation records), 49068dTank gauging results(and supporting documentation records) 490-6ae ATG Testing results(and supporting documentation records).490.6ar L Corrosion Protection 60-day logs 4906ss Equipment maintenance and calibration records. 490-68h IX.TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 49949a REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)499-69b OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)49069, CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS+9069d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49o-69e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"49o-69r ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS-49D.699 OTHER(Specify):MS9h,M69i This facility has a"Designated UST Operator"who hasp ed rhe lifornia ST System Operator E.rarrl 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 manner 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 overfills as specified in the UST Res > Names of contact person(s)for emergencies and monitoring alarms.490.10 p° Plan X. CONENIENTS/ADDITIONAL INFORMATION Provide additional comments hers 0-r indicate how many pages with additional informazion on spet:ific moniWri D g Procedures are attached to this plan 4900-1 S0- S c -.z w�iareID4se, °`��Rnfi>J. Qceve��on 0-•M.. XI.PERSONNEL R.ESPONSIMEITIES - The UST Owner/Operator is responsible for ensuring that:1)the daily/routine UST monitoring activities and maintenanceof 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 following persons)are responsible for performing the monitoring and equipment maintenance NAME j�f�N 'I'�(p 09(412 TITLE T��pyy/�/ NAME , L ' L !2t �AIIBt _ 4%-74 TITLE �n,4r, The Des gnateu lipcfdWi sna„ pc;.a,r a.aonthly visual inspection Of 1)12 FdC>11ty'. pr ivi` `o a orator,and In tORn tilt owner/0p2ra[Or Of ar15 conditions that need follow-up actionwne XILOWN1 RIOPERATOR SIGNATURE CERTIFICATION:I cert' tha the information provide erein is trueand accurate to the best ofmv knowledge. APPLICANT SIGNATU 490-T6 PATE 49A)_,1 REPRESE\TfNT i,Q,ner0 enior�:'`hn %kner0oenior r1 7 AuLh,r,,,-d APPLICANT NANIC(print) APPLICANT TLTIE lno-,9 __D O vv/ S UPCF UST-D(12!3007)3/4