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UNIFIED PROGRAM CONSOLIDATED FORM RECEIVE UNDERGROUND STORAGE TANK r MONITORING PLAN—(Page 2 of 2 VL UNDER DISPENSER CONTAMMU WDQ MONPTORM err itmt UDC MONITORING IS PERFORMED USING THE FOLLOWING MEIHOD(S) NTAL t�L H ❑ 1.CONTINUOUS ELECTRONIC MOABTD m 7 FLOAT AND CHAINASS8BLY ❑ 3.ELECTRONIC Srtcn pLT1LiY.,"SERVI . ❑ 4-NO DISPENSERSp ❑ ".OTHER(Specify) YCFiM�� LEAK MONITOR MANUFACTURER:- %R V CI woss_ MODELS: LEAK SENSOR MANUFACTURER: r awn. MODEL S(S): � DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND V6SUAL ALARMS. ❑ a.YES 11 b.NO atas9 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SNUfDOWN. 14 a.YES ❑ b.NO S. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN- ❑ a.YES I@ b.NO asosh. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. 1A a.YES ❑ b.No UDC CONSTRUCTION IS: L SINGLE WALL ❑ 2.DOUBLE WALL atom. asoaea IF DOUBLE WALL: UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a LIQUID ❑ b.PRESSURE ❑ m VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS- ❑ a.YES ❑ b.N0 vm PERIODIC SYSTEMTFST1NG 1.ELD TESTING:THIS FACILM HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED LEAK DETECRON MUST BE PERFORM®. PERIODIC ELD IS PERRM40)EVERY 36 MONTHS AS REQUIRED.Iii tis Burs.)). ® 2 SECONDARY CONTAI MIENTCOMPONRM ARE TESTED EVERY 36 MONTHS. . ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. VIII RECORD KEEPING atoa The following motdtoring/unintcnance icmids are leets Sox this fsality. a TANK INTEGRITY TESTING RESULTS ® a.ALARM LOGS IN b.VISUAL INSPECTION RECORDS ❑ ❑ d.SIR TFSI(NG RESULTS(and supporting documentation tecotds) ❑ e.TANK GAUGING RESULTS(and supporting documeatation records) f.ATG TESTING RESULTS(and supporting dommentatim records) ❑ g.CORROSION PROTECTION 60-DAY LOGS h EQUHWENT MAINTENANCE AND CALIBRATION RECORDS DL TRAINING Eg Personnel with UST monAmutg responsibt7iti me familiar 0116 aR of the following dnmmmts relevant M their job duties: a90-6� REFERENCE DOCUMENTS MAINTAINED AT FACILITY(CAeek all dW aPPIY) 490 qy ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 4soa ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Regeired) aso eye CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4, CALIFORNIA UNDERGROUND STORAGE TANK LAW ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND asacvr STATISTICAL INVENTORY RECONCILIATION- avo-a99 ❑ SWRCB PUBLICATION:-UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 49 1,. ❑ OTHER(Specify): ago-ser. r-who has to Catdmnia USC Sysa Operator Ehmm admmiaor d by the Iutemationel Code Carried aso.to This fatality has a"Dnsigomed UST Opetato F (ICC). The -Designated UST Operator-will train facility employees is the proper operation and maintetmnce of the UST systehts annually,and within 30 days of hire_This training will include,but is not limited to,the fallowing: DOperation of the UST systems in a manner mnsistent with tie facility's hest managemeat practices. D The facdW empioyre s mle with regard 10 the monitoring uNipmmt as specified in this UST Monitoring Plan. D The facility employee's role with regard to spills and waft&as specified in the f=hWs UST Response Plan. D Narne(s)of mntaet person(s)in,emagemies and monitoring alarms. 3L COIVUVIEN VADDMONAL INFORMATION asati Pmvidc additional comments here a and rate how many pages won anonar min mfartmtion on specific moonrtuting pm�=am aaached m this plan. O XL PERSONNEL RESPONSipuln ES* m a �usr meq t covered The UST OwnclOpador is responsible for msminB that 1.)the .datyAontUST montoriog activdim and by this plan oemts;2- all mnditioas that indicate a possible rime are investigated;and 3- a6 monituringrecorilis are me®mmed warmlyTHE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE- a 73. as M TITLE: n w , rlT 4 d sa NAME: Q� � �intt- nsa% - ais. �� 490-ter. TITLE. The Designated US Operator strait perform a monthly visual inspection of the facility,provide a report to the owamlopertm or,and inform the ownerlopemmr of any conditions that aced follow-u action. )LII.`OWN OPERATOR SIGNATIIRE CIMMCATION:I certify that the informstim PrOvItled herein is tree and am"rete to the best of my Imowledg0 aso-n. APPLICANT SIGNATURE DATE Dan % %-aspic %-a'- EPRESENtaMr. o R ❑1.Teck - a9a-ia. aS4t9. APPLICANT NAME(Print): - APPLICANT TTTLE: 4n%19 MIMLEimh UPCF USI'-D(1112007)-314 dO�� /2' ZO 17, 011F?vb �� (/ $o. Facer- C111