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1 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT MDQ MONITORING • 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 4s Ra I.CONTINUOUS ELECTRONIC MONITORING ❑I FLOAT AND CHAIN ASSEMBLY 9 3.ELECTRONIC STAND-ALONE 45ar4b ❑4.NO DISPENSERS ❑99.OTHER S PANEL MANUFACTURER: V l e t i w ery °sass MODEL p: - / r' .+�— 1 49as6. LEAK SENSOR MANUFACTURER L Z �( - ft, ., 49097 MODEL,#(S): '� DETECTION OF A LEAK INTO THIN UDC TRIGGERS AUDIBLE AND VISUAL ALARMS s9 ❑ a YES ❑.b.NO UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUFDOWN (9 a.YES ❑b.NO 4�, FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. Q a YES ❑b.NO 4�1 UDC MONITORING STOPS FLOW OF PRODUCT AT THE DISPENSER Q a.YES ❑b.NO 490.62 2.UDC CONSTRUCTION IS 1.SINGLE-WALLED ❑2.DOUBLE-WALLED °i IF DOUBLE WALLED: 49 UDC INTERSTITIAL SPACE IS MONITORED BY: Q 1.LIQUID 1712.PRESSURE 0 3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a YES ❑b.NO 49a64b VII.PERIODIC SYSTEM TESTING Lj t. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THIN STATE WATER RESOURCES CONTROL BOARD THAT ENHAbL= 490.69, K D N MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1 J2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490.66 3.SPILL•BUCKETS ARE TESTED ANNUALLY. 497 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: [Alarm logs 49 Ra ❑Visual Inspection Records 49 b gTank integrity testing results 49a6ac SIR testing results(and supporting documentation records). 4"d ❑ Tank gauging results(and supporting documentatio;r=ord&s):. 4�:e: ATG Testing results(and supporting documentation records).49or:sr ❑ Corrosion Protection 60-day logs 49 s Equipment maintenance and calibration records. 49 M UL TRAINING faPersomtel with UST monitoring responsibilities are familiar with all of the following documents relevant m the rjob duties. 4 REFERENCE DOCUMENTS MAINTAINED AT FACUM(Check all that apply) • IR THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Regi¢red)49a69b OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)49a69c CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49 % CALIFORNIA UNDERGROUND STORAGE TANK LAW 49o�69e STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"49CO-W SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490.69s OTHER(Specify):m69n ht 9 • f ., Ai".0 u . - 7 � f z n I o Uff This facility has a"Designated UST , for who has passed the Cal'omia UST S r The"Designated UST Operator'will train facilityemployees in the System Operator Exam admin' by the Nand within 3 Council(ICC). p proper operation and maintenance of the UST systems annually,and witlthr 30 days of hire.This training will include,but isnot 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 employce's role with regard to spills and overfills as specified in the UST Response Plan • Names of contact persons)for emergencies and monitoring alarms.49a70 X. COMMENTS/ADDITIONAL INFORMATION Provide additional _ A,or' i to how many papas with itional i o 'an(�on specific monitoring pFoced m this plan.49071 pV(�S ^'Wt t 'i�•'Y1,1M.. In 6 DILL fA�' �ILtrL. 9 1 s M.PERSONNEL RESPONSEaEUTIES 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 property. The following person(s)are responsible for performing the monitoring and equipment maintenance: NAME �<-:r ,brr 0 r, 49an TITLE C',.,"^t r 49an NAME t,4'� 3!1 r.-3 I 49 74 TITLE p^< '..:: 49a75 The Designated Operator shall perform a monthly visual inspection of the facility, provide a report in the owner/o tor, and inform the owner/operator of any conditions that need follow-up action. XII.OWNER/OPERATOR SIGNATURE CERTWCATION:I cedify that the information provided herein is tree and accurate to the best of my knowledge. APPL( ANT SIGN'131RE 490.76 DATE: 4W77 F Try amt 'v �AN APP C NAME :, °9p'18 APPLICANT TITLE: E490'm (P.I t) r- LllZ, rd' URCFu� a(�7/24a41u4Vj c� r /Zrzpd / Pec(r 1