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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 40 54z Oso-ae ❑ 11 CONTINUOUS ELECTRONIC MONITORING El 2.FLOAT AND CHAIN ASSEMBLY [13.ELECTRONIC STAND-ALONE V� 4'.NO DISPENSERS [1919.OTHER(SpccifY)___ PANEL MANUFACTURER: 09055 MODEL#: LEAK SENSOR MANUFACTURER 49057 MODEL#(S): 45°-50 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES ❑b.NO 490-59 IBC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES ❑b.NO 490,60' FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑b.NO 490s1 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER ❑ a.YES ❑b.NO 49062 2.UDC CONSTRUCTION IS []LSINGLE-WALLED ❑2.DOUBLE-WALLED 49063 IF DOUBLE WALLED: 496-640 _UDC INTERSTITIAL SPACE IS MONITORED BY: [11.LIQUID -❑2,P_RES_SURE_Q 3.VACUUM ____ _ A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE.AND VISUAL ALARMS ❑a.YES ❑b.NO 490-64b VII.PERIODIC SYSTEM TESTING - 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49°05. LEAK DETECTION(ELD)MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED_(23 CCR§2694.1)__ [SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. ° . Be—SPILL BUCKETS ARE TESTED ANNUALLY. 49067 VIII.RECORDKEEPING The llowing monitoring/maintenance records arc kept for this facility: Alarm logs 490s8a ❑Visual Inspection Records 4% b ❑Tank integrity testing results 490-68n ❑SIR testing results(and supporting documentation records). 490-68d ❑ Tank gauging results(and supporting documentation records). 497-6se ❑ G Testing results(and supporting documentation records).49ob8f ❑ Corrosion Protection 60-day logs 49o-68g Equipment maintenance and calibration records. 490-68h IX.TRAINING enonnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 00b9a REFE13ENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ©'THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)49U69b U'QPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)4906% O CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490.69e [g CALIFORNIA UNDERGROUND STORAGE TANK LAW 49aa% ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"49 w ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"49069, Tty h(Sapaify):M69e,MOi "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 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 UST Response Plan ➢ Names of contactperson(s)foremergencies and monitoring alarms.wan X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional inion union on specific monitoring procedures are attached to this plan.49071 Cwt i l ( reg✓erg 1,0A u ; li r a la rm sed- c D&0 .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 person( are msporui br for performing the monitoring and equipment nance. . NAME 4%72 TITLE 4W73 NAME e 497-74 TITLE 490-75 The Designated Operator shall perform a monthly visual inspection of the facility, provide a reporto the owner/operator,and inform the owner/operator of any conditions that need follow-up action. XIL OWNER/OPERATORSIGNATURE CERTIFICATION:I certify that the info tion provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE V 490-76 DATE: 490-70 xili er/ 3. urhm-dRe naive r xm APPLICANT NAME(print): am. 490-7e APPLICANT TITLE: 69079 C C VAC✓er �� E�I ✓10. ,2 ©�12ltr�Ol UPCF UST-D(12/2007)3/4