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RJUNIFIED PROGRAM CONSOLIDATED FORM or UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54 111.CONTINUOUS ELECTRONIC MONITORING W 2.FLOAT AND CHAP]ASSEMBLY El3.ELECTRONIC STAND-ALONE 49 1, ❑4.NO DISPENSERS ❑99.OTHER(Specify): __ PANEL MANUFACTURER: B�A VO 490-55 MODEL# C —`— —'--___- _�510�_ 49056. LEAK SENSOR MANUFACTURER: 490.57 MODEL#(S): 490-58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES W b.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES b.NO 490'60 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES !$J b.NO 490'61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. W a.YES ❑b.NO 49062 2.UDC CONSTRUCTION is X I.SINGLE-WALLED 112.DOUBLE-WALLED 49063 IF DOUBLE WALLED: 494: UDC INTERSTITTAL SPACE IS MONITORED BY:_ 1.LI UID 2.PRESSURE ❑3.VACUUM_ A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES b.NO 490-64 VII.PERIODIC SYSTEM TESTING ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT EN11ANCED 49065. EAK DETECTION(FEDI MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED (23 CCR&26441) 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49o.c6 3.SPILL—BUCKETS—)RE TESTED ANNUALLY. --41� VIII.RECORDKEEPING The following monitoring/mainumance records are kept for this facility: �1 Alarm logs 490494 ❑Visual Inspection Records 490381, ❑Tank integrity testing results 49 m SIR testing results(and supporting documentation records). 490-694 ❑ Tank gauging results(and supporting documentation records). 490-689 ATG Testing results(and supporting documentation records).49038r ❑ Corrosion Protection 60-day logs 4190-68, Equipment maintenance and calibration records. 419oUati M.TRAINING $f Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. 490x9. REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490.691, OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)a9oa9< ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490694 ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490.69, ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: `HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"49ocsr ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-698 ❑ OTHER(Specify):m69e,me, This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the httematioml 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 marmer 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 D 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.490-70 X. COMMENTS/ADDITIONAL INFORMATION Provide additional cora rm��ents here or indicate how many pages with additional information on specific mothis nitoring procedures are attached to plan.490-71 I Y XI.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 following person(s)are responsible for performing the monitoring and equipment maintenance: NAME 490-72 TITLE 010. ==q0% Q 49073 NAME 49x74 TITLE °9075 The Designated Opemtbr shall perform a monthly visual inspection of the facility,provide a report to the owner operator,and inform the owner/operator of any conditions that need follow-up action. XII.OWNER/OPERATOR SIGNATURE CERTIFICATION:I certiftillat the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNA 490.76 DATE: 49x77 G ' ❑2F e 0. 1 iv f Do V ' ooa APPLICANT NAME(print) 490-79 APPLICANT TITLE: 490-79 UPCF UST-D(12/2007)3/4