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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 490-544 ,�ter••,, 49as4n W.1.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHER S i ): PANEL MANUFACTURER: \f MPLb Q.IL O-D T• 4so-ss MODEL#: T L S 4 56 LEAK SENSOR MANUFACTURJ a9s7 aMODEL#(S): y+ DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a YES ❑b.NO ° w UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES ❑b.NO ago-6o. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a YES ❑b.NO 49361 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER ❑ a.YES ❑b.NO 490c2 L UDC CONSTRUCTION IS ❑L SINGLE-WALLED 0,2.DOUBLE-WALLED 090.63 IF DOUBLE WALLED: 490334 UDC INTERSTITIAL SPACE IS MONITORED BY: L LI UID 2.PRESSURE 3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINME OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS a YES ❑b.NO 4v0.64n VII.PERIODIC SYSTEM TESTING 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT f&H&NM 4oW. ___JZAL DETECTION(ELD)MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1 [12.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49°66 %3.SPILL BUCKETS ARE TESTED ANNUALLY, 49a67 VIII.RECORDKEEPING Tile following monitoring/maintenance records are kept for this facility: Alarm logs 490684 Visual Inspection Records 49oagn ❑Tank integrity testing results 4v k SIR testing results(an supporting documentation records). 4so-6ea ❑ Tank gauging results(and supporting documentation records). 46+ ATG Testing results(and supporting documentation records).4s f ❑ Corrosion Protection 60-day logs 49 sg uipmenl maintenance and calibration records. Oso M IX.TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. 490.694 FM ME ENCE DOCUNTS MAINTAINED AT FACILITY(Check all that apply) S UNDERGROUND STORAGE TANK MONITORING PLAN(Required)480..69690PERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)469c ALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490694 ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49069e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"4s f ❑ S WRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"4e 698 ❑ OTHER(Specify):m69q m NThis facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(ICC). e"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 w 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 person(s)for emergencies and monitoring alarms.4s0.70 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 ) i �C-t.A� •Ci � �s�U "-+�ti XI.PERSONNEL RESPONSIBILITIES The UST Owner/Opemtor 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)allonnoring records are maintained properly. The followingn(s)are res nsible for performing the monitoring and equipment mains _ NAME 49o7z TITLE 440-73 NAME N 490-74 TITLE 1 490-75 The Designated Opereor shall perfo a monthly visual inspection of the facility, provide a report to the owner/operator,and inform the owner/operator of any conditions the need follow-up action. XII.OWNER/OPERATOR SIGNATURE CERTIFI TION: I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICAN IGNATURE /I 49 76 DATE: 4so.77 I .v / I I A R r APPLICANT NAME( 490.79 APPLICANT TIIL ' ' 450-79 r UPCF UST-D(12/2007)3/4