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TTNIFIIsD PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN—(I'M 2 Of 2 awax all S'Y.i3NI'1Eit'�L�P�1�lS�iC:G�PA1�" �'�'��'�,[E1rF©1t�NG r�,ra i UDC MONTTORItG LSPERFORMED USING THE FOLLOWING MET'HOD(S) 3.ELECTRONIC STAND-ALONE asaaa. [! 1 C0P7I17NlJOUS ELECTRONIC MONITORING N 2.FLOAT AND CHAIN ASSEMBLY ❑ nr gyasy, s+ ❑ a.NO DISPENSERS ❑ 90'OT14ER ' MODEL N: �sosa LEAXSENSORMANUFFCTUM-IL +�'. MODEL Y(5): MTECTINSOR A LEAK INTO YES >�b.NO aso.ss i DETECTION OF A LEAK 1NC0 TF1E C1DC TRIGGERS AUDIBLE AND VISUAL ALARMS. gyo`p ryry a.YES �b.NO i i UDC LEAK ALARM TR)CIOERS AUTOMAT CC PUMP SHUTDOWN. V YES b.NO tgayt i i FAILURSOZSCONNEC ION OF UDC MONfrORING SYSTEM TRIGGER".=i)TOMATIC PUMP SHVT'DOWN. JR YfiS ❑ b.NO . UDC MONITORING STOPS THE FLOW OF PRODUCT AT TIM DISPENSER- --,. i UDC CONSTRUCTION IS- ]® I SINGLE WALL 132.DOUBLE WAIL IF DOUBLE WALL. PRESSURE Q o.VACUUM i UDC INTERSTITIAL SPACE Is MOMfORF.D BY. ❑ a LIQUID 13b A LPAK WITHIN THE SECONDARY CGNTAIN)>SNT OP THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS- ❑ a YES ❑ b.NO : . 0 _ . . . 1,p.LD TASTING: NITS PACIHAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD TNA7 ENHANCED LrfY j ON MUST BE PERPORh'ffiU. PERIODIC BLD IS PERFORMEVERY 36 MONTHS AS ED D.less ® 2.SECOTIDARY COMAIIMENT COMPONENTS ARE TESTED EVERY M MONTHS- � j�3.SPILL BUCKET3 AAS 7E5TEIANNUALLY, , . The followblg rronrtoriaglmsesreaaaae records are kept for miS WIPryi a TANK INTEGRITY TESTING RESULTS 0 a.ALARM LOOS 4Q b.VISUAL INSPECTION RECORDS ❑ Baena w atwn cords) d.SIR TESTING RESULT (and supporting docunxrtaGoa moods) ❑ e.TANK GAUGING RESULTS(ate supposing C ATG TESTING RESULTS(aud suppordng dorJrraantation xrards) ❑ %.CORROSION PROTECTION 60-1DAY LOGS h MAINITNANCE AND CALIBRATION RECORDS EC Persoeael win UST mmiM++n%rwpaosib74nea are Gmt7ivw�dI of fhe mllowmg dowrtunte tekraatm thou Job dmies: amtsr. iREFERENCE DOCUMENTS MAINTAINED AT FACILITY(C3aakaUthat apply) amssa 0I THIS UNDERGROUND STORAGE TANK MONITORING PLAN PLAN(taegeleedy Na»a® OPERATINGMANUALS FOR ELECTRONIC MONITORING EQUWMENT(Req-fired) �so.caa ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS rr. i Q CALIFORNIA UNDBRGAOI/ND STORAGE TANK LAW ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS MANUAL AND aandar STATISTICAL IN VENPORY RECONCILIATION' +aa•69a- ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" ase. ❑ OTHER(Specifi): Tides beiRty has a«Designated UST OpambNe who hese Wssad the Ltlrb'omte U T$3 Sam Operator Emm .oft eied by the Iase®tional Cade Lbuned •rO- ' er"will train®e7dY employees ID the proper operation and mnbrterr� dhe UST systems annea77y,and wimia 30 PCC) The "pesignatd UST Opcmto days oTidtc-Thin tiamivg will inolndq but is not limited W.the foLLowing: iY Operation of the UST sysmms as a manner agnsLSu.Ptwiththe facility's hest matnaSnm t praetitaS. D The fuility anployee's rote wigs regard m the awaimrhrg eq-il) m aS SPocifird to this UST Mnnitming Plan. f The fatuity employee's role with raged to spills and overfills as SpWificd in the fAcift's UST Response Plan, > Narm(e)o(mmuA pansoa(s)for emerganciec and monimrmg akatrm. .. an att3ehed m lhis d+a asatl. Prov.de additional oormaate hero a rtiditJm how man'Pages with addlimnel infomntion ca specllc mmhonng Ixocemrtas of UST leak tiHaction quipment covtrW I'ha U5T tTvaar/Opararar s mponeibm fm ensuring that: 1.)me dmly/naahae UST mookaresg acavdsa sad k>noCa e hI'.khis fine •2. all condirieag that indicate a ossibk rrdease aro iovcatieyted:and 3.)311 ords nrronlmo reeare rseirrmirted propcty. _..� I THE FOLLOWING PERSONIS)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQ011Iv1BNT MAINElI"CE: I NAME: 'Aa Tl7TE: n NAME: ao.. — iso n. TtTT E I'ne Oastgnated U57 Operator sltaR prjform a montbty visanl inspeetton of Sbe Scdity.piovtde a report to the owau/opcmtoS aM inform the ovmer/opanmr Of any conditiom Watumd follow scfon. i CERT'rP1G17ONc T eri w that the informs rovided 4ereW is trueFD—ATE. Ee best of my Imaav, .wn APPLICANT SIGNATURE i N4YRGSENIAQ I.T 3.tudmnadgD �3Y r. O9J.19 APPLICANT NAME(Out): APPUCANTTItLE: tPPCF USIA(12r203T).3/4 www.onitloca.org s 4-z9-�9 i b0/b0 39Vd OINIID A8nrNI -1-1C Z906179660Z L0:T0 S00Z/0T/80