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UNIFIED PROGRAM CONSOLIDATED FORM err/ UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 2 of 2 VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING (check all that apply) UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 490-54e. ® 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 491-s46. ❑ jNNNO.DISPENSERS ....._____.....____._1._99:.OTHERLSpecify)____........__________.._.-__..........................................._____-...______....___._ LEAK MONITOR MANUFACTURER:Veeder-Root osass. MODEL N:TLS-350 a9as6. 49x57. MODEL N(S):Liquid Sensor Series 796380-208 49xsa, LEAK SENSOR MANUFACTURER:Veeder-Root au49as9 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ® a.YES ❑ b.NO UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. N a YES ❑ b.NO 49xb0_ FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑ b.NO 490'61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. _., ®._a_YES _Q b.NO 49D61 UDC CONSTRUCTION IS: ® 1.SINGLE WALL ❑ 2.DOUBLE WALL 4906]. 49°-64a. IF DOUBLE WALL: UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO 499646. VII. PERIODIC SYSTEM TESTING ❑ 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49x65_ LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED,[23 CCR§26x4.1) El 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490 ® 490-67 3.SPILL BUCKETS ARE TESTED ANNUALLY. VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 49061. ® a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) ❑ f ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS M h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING M Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties: 49x69.. REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490-696. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 4%69c ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49a69d_ ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49x69e. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 49069[ STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS', ago-69g. This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 490-70. (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 facility's UST Response Plan. ➢ Name(s)of contact person(s)for emergencies and monitoring slants. X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan. 490-71. • UST TURBINE&FILL SUMP MONITORING. PANEL MANUFACTURER: Veeder-Root MODEL TLI-350 LEAK SENSOR MANUFACTURER:Veeder-Root MODEL#(S):Liduid Sensor Series 794380-208 • AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR DOUBLE WALL TANK(S) PANEL MANUFACTURER: Veeder-Root MODEL 4: TLS-350 IN-TANK PROBE MANUFACTURER Veeder-Root MODEL#-. MAGI • OVERFILL PREVENTION METHOD:FILL TUBE SHUT OFF VALVE DPW 61-SO-PT a 95 EVR ISD Software Installed 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 occrus;2)all condmons that indicate a possible release are investigated;and 3)all monitorin8 records are mamtatned properly THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE NAME: 490-72_ TITLE:Manager: 49x73. NAME: 49x74. TITLE:Asst Manager: 49°-75. The Designated UST Operator shall per rn a monthly visual inspection of the facility,provide a report to the owner/operator,and inform the owner/operator of any conditions that need fiello -up action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify tha le information pr9vided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 490-77 REPRESENTING:®1.Sank Owner/Opaeror ❑2. wner/O r❑3.AuNorized RepresentauveafOwnu 49x76. 06/10/2009 APPLICANT NAME(print): 49x71. APPLICANT TITLE: 490-79. Chevron Products Co./JIM MAN Chevron Retail HESSpecialist (Ager use only) Thu form M1n been a www tad: Approved❑ Approved with Conditions❑ oie.pproved I al Agmey Sianatuse: Date: