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RPENIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN (Page 2 of 2) <br /> VI.UNDER DISPENSER CONTAINMENT,(UDC)MONITORING 9o-sn. <br /> 0=::! <br /> ORING IS PERFORMED USING THE FOLLOWING METHOD 490-sob <br /> OUS ELECTRONIC MONITORING %1 FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE <br /> NSERS ❑99.OTHERS ify): MODEL#: 490-s6. <br /> UFACTURER: 49o-sr MODE.#(S): -sa <br /> R MANUFACTURER: a.YES b.NO49o-s9 <br /> N OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ 490-60 <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a ES [b.NO <br /> p� a. a9a6t <br /> FAILURE I DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a ES [Ib-NO 49 2 <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER 490-63 <br /> 2.UDC CONSTRUCTION IS 1.SINGLE-WALLED ❑2.DOUBLE-WALLED 490Na <br /> IF DOUBLE WALLED: <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: ❑1 LIQUID ❑2.PRESSURE 3.VACUUM 49o-64b <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.ES ❑b.NO <br /> VII.PERIODIC SYSTEM TESTING _' 90 6s. <br /> NC <br /> ❑ 1� ELD LEAK TESTING: <br /> THISLD FACILI C: <br /> BE PERFORMEDT PERIODIC LE DIS PERFORMED EV RY36 MONTHSRAll II UIRED(223 CC §2644.1 <br /> D <br /> 490b6 <br /> 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-67 <br /> 3.SPILL BUCKETS ARE TESTED ANNUALLY. <br /> VIII.RECORDKEEPING <br /> The following momtonng/maintenance records are kept for this facility: <br /> },Alarm logs 490 68a Visual Inspection Records 490-6sb El Tank integrity testing results 4w6ee <br /> n SRR testing results(and suppoRing documentation records). 4% Sd ❑ Tank gauging results(and supporting documentation records). 49oaee <br /> ❑ATG Testing results(end supporting documentation two S).490-68f ❑ Corrosion Protection 60-day logs 49ob99 <br /> Equipment maintenance and calibration records. 490-6eh <br /> IX.TRAINING <br /> Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490b93 <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) <br /> THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)49o.69b <br /> OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490fi9a <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490s%d <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW M9 Re <br /> El STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION"490-69f <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"49M9, <br /> ❑ OTHER(Specify):M69h.M69 <br /> This facility has a"Designated UST Operator"who has passed the Califomia UST System Operator Exam administered by the Interactional Code Council(IC <br /> 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 <br /> training will include,but is not limited to,the following: <br /> D Operation of the UST systems in a manner consistent with the facility's best management practices <br /> ➢ The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan <br /> ➢ The facility employee's role with regard to spills and overfills as specified in the UST Response Plan <br /> ➢ Names of contact person(s)for emergencies and monitoring alarms.490.rc <br /> X. COMMENTS/ADDITIONAL INFORMATION <br /> Provide additional comments here or indicate how many pages with additional infomtation on specific monitoring procedures arc attached to this plan.a9o-rt <br /> ©vep'VI,U PREUENT; ON F� <br /> RPPEIk <br /> -IS RT 4s `/- of IANK CAPACi T <br /> XI.PERSONNEL RESPONSIBILITIES <br /> The UST Owner/Operator is responsible for ensuring that: 1)the daily/routine UST monitoring activities and maintenance of UST <br /> leleak detection equipment covered by <br /> this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)ail monitoring records are maintained ro rl <br /> The following persons)are responsible for perf mond the monitoring and equipment maintenance: 490-r3 <br /> 1 490'2 TITLE — QR s 49 75 <br /> NAME Spt 490.74 TITLE <br /> NAME <br /> The Designated Operator shall perform a monthly visual inspection of the faci `provide a report to the owner/operator,and inform the owner/operator o any <br /> conditions that need follow-up action. <br /> XII.OWNER/OPERATOR SIGNATURE <br /> CERTIFICATION:I certi that the information provided herein is true and accurate to the best of my knowledge. 49 V <br /> 09076 DATE: <br /> APPLICANT SIGNATURE o A bt j 10 <br /> t3 <br /> T k Own /0 erm r rl 2 Fazili Owner ervor 3.AUNon Re resentauve r 090-1 <br /> 690'8 APPLICANT TITLE: <br /> APPLICANT NAME(print): V iC E P E ' E N <br /> SPf-ri NJ)Et2 <br /> AF_V Aki <br /> UPCFUST-D(12/200/)314 �� � G ^�V J- �� V ` v <br />