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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD V I.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC.STAND-ALONE ❑ 4.NO DISPENSERS ❑99.OTHER(S eci ----- PANELMANUFACTURER: �- MODEL#:TL-5 —__ LEAK SENSOR MANUFACTURER: MODEL#(S): DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS a.YES ❑b.NO UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN [g a.YES ❑b.NO FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. P9 a.YES ❑b.NO UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. R a.YES ❑b.NO Y.UDC CONSTRUCTION IS []l.SINGLE-WALLED 2.DOUBLE-WALLED IF DOUBLE WALLED: UDC INTERSTITIAL SPACE IS MONITORED BY: L] 1.LTQUID LK2.PRESSURE M 3.VACUUM __-__ A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS a.YES ❑b.NO VII.PERIODIC SYSTEM TESTING ❑ I. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. CCR fi2644,1)_,.---____ ❑2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. ------------------------ . ___ _ ___ --- 3.SPILL BUCKETS ARE TESTED ANNUALLY. VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: pN Alarm logs 5 V isual Inspection Records ❑Tank integrity testing results 0 SIR testing results(and supporting documentation records). ❑ Tank gauging results(and supporting documentation records). ❑ATG Testing results(and supporting documentation records). ❑ Corrosion Protection 60-day logs [Equipment maintenance and calibration records. M TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) g THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) Or OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" ❑ OTHER(Specify): 5a This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam 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•vill include,Fut is not limited to,the following: ➢ Operation of the UST systems in a manner consistent with the facility's best management practices D 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 Response Plan • Names of contact persons)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicatehow many pages with additional information on specific monitoring procedures are attached to this plan. XI.PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that: 1)the daily/routine UST monitoring activities and maintenance of 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 folio g persons)air re on ibl for performing the monitoring and equipment mai na cc: NAME TITLE NAME TITLE The Designated Operator shallperform a monthly visual inspection of the facility, provi a report to the owner/o rotor, and inform the owner/operator of any conditions that need follow-up action. XII.OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGN DATE: APPLICANT NA E(print: APPLICANT TITLE: , I ro UPCF UST-D(12/2007)3/4