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L .7N;ri PROGRAM CONSOLIDATED JHORM UNDERGROUND ST[ RAG-F TANK MONITORING PLAN (Page 2 of2) VI.UNDER DISPENSER CONTAINMENT(UAC:)MON ITORING 1. UDC MONITORING IS PERFORMij)US NG THE FOLLOWING METHOD 49454b ❑ 1.CONTINUOUS ELECTRONIC MONITORING ❑'.-1' .OAT AND C14AIN ASSEMBLY ❑ 3.f'.C.F(-TP ONIC STANI`AI.ON£ ❑d.NO DISPENSERS_J,�99;OTHER 5 ecifyl: �-MODEL--,-S--- .. .......-- PAI��EL MANUFACTURER: �- _.__ MOT)FI.#: 3V............. ... VES �.__. �; . ... — 47ft-45 , w- 47u�i7- +190-5F LEAK SENSORMANUFACTURIiR_ V LV f1 !� o`7Q�f3yd _ DETECTION OF A LEAK INTO THF:LIDC TUGGERS AUI}IBLE AND VISUAL ALARMS ❑ a.YES ❑b.NO 490 i4 UDC T F.A1C ALARM TRIGGERS AUTOMATIC PUMP S14UTDOWN ❑ n YES ❑b.NO FAILURE./DISCONNECTION OF ITDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ aa.YTiS ❑h.NO ago 6r UDC:MONITORING STOPS TIM CLOW OF PUODITC'T AT THE DISPENSER. ❑ a.YES ❑b,NO a9ut,z . ...- .-.._... .19"3 2.UDC CONSTRUCTION IS ❑I,STNGLE-WALLETS ❑2.DOUBLE-WALLED AD IN' P,ItS TI'f THE SECONDARY MONNUCJNF.D T4Y: n i.l.101TID- ]2_PRESSLIRA _.C1 1 VACTTTli.4 . __ IF DOUBLE WALT.ED WIT _ :iAI4n4h TAINMEN"f Or,TI'IE UDC TRIOCiER.S AUT)MLE AND VISUALALARMS Da-YES ❑b.NO _ VII.PERIODIC SVSTEM'TESTING 1.ELD TESTiNQ THIS FACnJTY HAS BEEN NOTIFIED 137 TIIL; STATE WATER RESOURCES CONTROL BOA'kf)THAT�jHANCED 48465. --LEAK DETECTION ELD MUST BE PERFORMED, P-F,TLTOTyTC FLD TSPERFORMED ED EVERY 3b MONTH S AS I !2Q ED123 CCR644µ1)s{ ©2.SPCONDARV C-ONTAINMBNT COMPONENTS ARE TESTED EVERY 36 MONTHS. _ Q 3,S1'TLI r)<U65FF S AR.E TESTF;D ANNIJAI.D _ 490-67 VIII.REGORDKEEPING Tltc follow®g mantwriuglmuLmtrnana c reeorrlS sic kept for this facility: ❑Aicurrt loss 4'x1-W. ❑ViwW 131,Tc6an Records 4nn,wh ❑Tank inteRtity tasting n-svlls 4%-MA {j SIR testing results(and gnpponing documentation records). 490a8d ❑ Ttuik gnuginr,moult.(und supporting,documentation records), 4984 ,; El ATG Testing results(tnnd supporting documentation re+arrils),4gn.s91- ❑ Con'asion Prataotion 60-day logs 4!>009 ❑Equipmuntmuintenuncu and calibration rewrds. 4WoMj, _......,--- __._...., IX.TRAIN fN(. — Persomxrcl with UST monitoring responsrhilifies arc familiar with A of _— uiTjo . t -._.,.._ ._,..-... ... ❑ g the folknwing doeumr.'nts relevant to thou job duties. 40.'u,% REFERENCE DOCUMENTS MAINTAINED AT FACILITY, (Chi k all Lhat apNly) ❑ THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Rcquind)Oso-a91+ ❑ OPERATING MANLfALS fOR ELECTRONIC MONITORING CQUIPMSNT(Required)4sa4rk ❑ CALIYORNTA UNDERGROUND STORAGr TANK REGULATIONS d9u-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490.tiw ❑ STATE WATER RESOURCES CONTROL BOARD (S'WRCB) PUBLICATION; "l1ANDr100K FOR TANK OWNERS - MANUAL AND STATISTICAL rNVEWORY RLCONC.EL ATfON-4o"or SWRCB PUBWATTON:"UNDER-STANDTNG AUTOMATIC TANK GAUGING SYSTEMS"4?o-mr, ❑ OTHER(Specify):Mwu,W)i __. . _......... .._.-_.__._....- This Facility hag a"DegiVated UST Operator who has passed the Califorin UST System Opentlor I',xam:ulmini t=A by the International Code Council(TCC). The`Desigmted UST Operator-will train facility employees in the proper npcm1iun:md mainwnwl:c of the UST systems annually,and within 30 days of hire.This (wing welt ml ludr,bul iN not htrta4tl IU,the following; 3 Operation ofthc UST sygtcm4 in a manner l:W4istcnt A'ith the facility's best managernuat practices Y The laaflity employee's role with regard to the monitoring equipmcni as spe shied in this LIST Moniuering l`lan P The Sucility employee's role with regard to spills imd ovcrtills us sprcilied in the LAT Rcsponsc flan Y Nam"of wnuwL persou(s)for Linagtencica and mvnilurmt,uIP M 4+00-70 X. COMMENTS/ADDITIONAL INFORMATION Provide additional corrduurats here or indicate how,aauy pages with additional information on specific monitoring procedures am utlw:iwd to nhi_,lrisu.1190 71 X.I.PERSONNEL RESPONSIBILITIES _ The U'ST Owncr/Operator is wspoetglble for L-nsnr'mE`that:1)the daffy/routine UST monitoring acdvi Lies and mainju nancc of LIST leak dcwc6oA equipment covered by this plan occurs.2)all conditions that indicate a possible release are investigated,mud 3)all monitoring records are maintained properly. The following person(s)are responsible for performing the monitoring and erquipmens ataialanance: NAME S 1 A1&W 440.72 TITLE 0W A/f,4- 490.73 NAME r. Ken RdT 4W-74 TITLE ©1r''AIJZ- 49C75 The Designated Opcmtor shall pc-rforsu a enontltly visual inspection of the facility,provide a report to the ownerlOP;alor, and inform Lhr ownt7'IopL7xor of any conditions that need follow-up action- __ _ XII.OVI'IYEIZ/OPERATOIR SIGNATURE - CEitTiFIC ` ,TIONcertify t the informationinformationprovided herein is Iruc and accurate t0[Fie best ofmV Ictlotm+Iefte, APPLI IGN I40 76 DATE:Jk7UPOma 77 > ;: I,_T- k-pkn r( or -Z,rx li Ilam or APPLICANT NAME(print): axn.7K APPLICANT TITLE! 4 77 I S 1Al W N 11c- UPCF UST-D(I 2J207)3/4 took 000dVSVDd0HH,L�v I OL926CZ60Z YV3 CV:CT 600Zi9T/T0