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NOV-13-2013 15:09 From: 2098254549 To:4683433RECEl RECEIVED <br /> 1.21013 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK ENVIRONMENTAL <br /> MONITORING PLAN (Page 2 of HEALTH DEPARTMENT <br /> VI.UNDER DISPENSER CONTAINMENT )MONITORING <br /> j 16 L UDC MONITORING IS PERFORMED USING TM FOLLptVING 1METHOA w9sts <br /> I,CONTINUOUS ELEC7ROMC MONITOR.(NG ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3 ELECTRONIC STAND-ALONE <br /> ❑4 NO DISPENSERS Q99 OTIT£ Shea ). <br /> PANEL MANUFACTURER.. �`�y�`�'-' ^-+-- <br /> ..4.ft is eY eso-ls . MODEr r L 3'$Q "a <br /> LEAK SENSOR MANUFACTURER Is Ir i90.5r MODEi M(S 'si nPa <br /> DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWNa.YES [3t- nJ <br /> ip a.YES Q b.NO a9oao <br /> FAILURE f DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. %.YES ❑b.NO N0e1 <br /> ;._UDC MONITORING STOP THE FLOW OF PRODUCT AT THE DISPENSER e_YES obi <br /> NO ewer <br /> 2.UDC CONSTRUCTION 1S I SINGL6WALLED Q.DOUBLE-WALLED <br /> IF DOUBLE WALI.RD: 1, <br /> j..,_...URC INTERST[7TAL SPACE 15 MONITORED BY. I.LIQUID_p 2�PRESSu1tE -�]3.VACUUh�7 �__ - _ <br /> _ A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 99°60 <br /> VII.,PERIODIC SYSTEM TESTING <br /> • ❑ 1 ELD TE3TING', THIS FACILRV RAS BEEN NOTIFIED BY TFBi STATE WATER RESOURCL4 CONTROL BOARD TTyA7 RANC6D <br /> L N MUST BE.PERFORMED; PERIODIC ELD TS PERFORMED BY 36 MONTHS AS AEOUIRED. 23 CCR 26aa 1 <br /> SECONDARY CONTAINMENT COMPONENTS ARE TESTEp EVERY 36 MONTHS. -(� �—isoa <br /> ! 3 SP4L BUCKEI"ARE TESTR"`A UALLY�.�T"` <br /> arpar <br /> — VIIL RECORDK EPHNG <br /> The foEo_"e menitOM Man,tecprdg are kept for this faCdiry <br /> ens <br /> IOg9 •9Daea Visual Tnspectioq Reeetda NO-a86 Tank mieg[iry[eating rtaW6 yo{{s <br /> SIA mspng results( soppomng aocumenta0on rerotds). a9oaw d Tans gauging rsem (and epppmt(0g dxamrenpbap earH <br /> ATG testing reaW tg(and supporting documentation ferords).s9nser 0C . <br /> Protalioe 6n-dM logs ams ). ssU� <br /> 4 <br /> ❑bgYpment ltlaimm�anee and cpllbreti00 ttcotdS. a90dah <br /> IX.TRAINING <br /> .$011091 ill UST mommnng fespo0slbilibes are familiar with all of the following documents fdlgv m to deb job duties. N90e9a <br /> wFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check All that apply) <br /> D '1 UNDERGROUND STORAGE TANK MONITORING PLAN(Rrqulred)491 <br /> 0 OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)woa99 <br /> „ C CALIFORNIA UNDERGROUND STORAGE TANK RBOULATIONS sway, <br /> C CALIFORNIA UNDERGROUND STORAGE TANK LAW swasa <br /> I u STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS . MANUAL AND <br /> i STATISTICAL INVENTORY RECONCILIATION'mW <br /> C SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK OAUCJNG SYSTEMS"s9ot+,ry- <br /> C OTHER(Specify):b*Wtea9m <br /> j Thu facility bas a"1: 1, 1tatcd UST Operator"who has pseud the Galtfoma VST SYstwn Operamr Eaam adroimsi by the Intematiotnl Code Council(ICC). <br /> The"Dasig'led UST Operator"will brain facility employ=m the proper operation end matmeuance of the UST systems enaually,and within 3O days of hbe.Thu <br /> uatmng will mClUde,but 13 not limited to,the follow)tlg' <br /> > OpenUon of she VST systems in a manner conststcnt with the fkethty's best managervel practices <br /> > The facility employee's role with reg,rd W the monnormg equipment as apeciflcd in this UST Monitoring Pim <br /> > The fmiliry employs"role wlm regard to spills and overElla as speoifted to the UST Reapome Plan <br /> > Names ofconma pusan(S)fa <br /> e4mrienctes and monitoring aiamu.4y 70 <br /> ._. X. COMMENTS/ADDITIONAL INFORMATION <br /> ''Provrdc additional mpanmts ham or udiraR how man with additional mfomurion on spxifie muni <br /> a11h@�/ C" ) �/����� toting pmeNwas am anaelmd to this plan,non <br /> w ( 6 <br /> Xl.PERSONNEL RESPONSIBILITIES <br /> The UST OwnWoperamr is responsible Tor stil g that. I)the daily/routine UST mondon mr,vibes and maintenance of UST halt detection equi <br /> this Plan oxrm,2)all conditions that indicate a possible releue are invesnW � m Omani collared hY i <br /> .Tile forlawi person(Y)em mspooslhle for performm the memwr W anA �'and 3)all monasormg record¢ase tramtained properly. <br /> NAME ,� s-s�j [f equspmens m¢intenvrc¢ <br /> NAME 4w-Ta TITLE sw n <br /> /ill -TITLE M73 <br /> I Thu Ileus dile <br /> ed Poll r ahail perform a monddy .isy t inspxpon of the facility,provide s myon W the owner/operator, and infetsn the owrmr/o <br /> fconditions thus raid lollov-vp lesion. pvaser of any <br /> (Aait�13 h <br /> CERTTRNT N:I cert(fy that tic XD.OWNER/OPERATOR SICNAT <br /> AP,P)dCANT BION info in ided herein is trot Md acruMe to do bee my knowledge. <br /> SIGNATURE ,! troan4sl DATE <br /> NOV a 401S , 49pV <br /> -1 APPLICANT NAME(print) n. 49p3 <br /> APPLICA � -o <br /> UPC:F UST-D(IV21131 LA <br />