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PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN— 2 of 2 (C'heckall VI.UNDER DISPENSER CONTAINNT(UDC)MONITORING MEtar h) UDC MONITORING IS PERFORMED USING THE FOLLOWING METHODS) ra.va L CONTINUOUS ELECTRONIC MONITORING ❑ 2 FLOAT AND CRAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 49094n ANO DISPENSERS _ ❑ 99.OTHERS ) Jtt"s NLODEL 4: �- LRAKMONITORh142i11; C7URIILv J9as_ & LEAF SENSORMANUFACTURER: [ • AIODEL#(S): W4 - e� s9 DETECTION OF A LEAF INTO THE UDC TR[GGERS AUDIBIE AND\TSU.AL AL1RhIS. a.YES [I b.NO �a YES ❑ b.NO ,9060. UDC LEAK ALARMIItIGGERS AUTFOMATIC PCMB SHUTDOWN. WWW 49a6t F,A]LtTREDSCONNEc,nONOFIlDCNION(TORDIGSYS[ENtnUGGERS.4LTFONIATICPLMESHUTDOWN. $a.]TES ❑ b.NO , UDC MONITORING STOPS THE FLOW OF PLODUCT AT THE DISPENSER _ _.._....._ a.YES ❑ b.NO - UDC CONS7RUCIION IS: 131.SINGLE WALL f1DOUBLEWALL 49D41a IF DOUBT E W 4•L_ b.PRESSURE ❑ c VACUCMI UDC INfERSTITTAL SPACE IS MONITORED BY: �a LIQUID ❑ J9u6,a. A LEAF:,%TrH N THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND\TSLtAL ALARMIS. a.YES ❑ b.NO VII. PERIODIC SYSTEM TESTING L 11.D TESTING: THIS FACH.ITY HAS BEEN NOTIFIED BY THE STATE M PIER RESCKTRCES CONTROL BOARD THAT EI`m ANCED J90'6` D C NRtS7 BE PFRFORhED. PERIODIC ELI)IS PERFORMED EVERY 36 MONTHS AS RE USED.123 ct.'n 9_6u.1 4906s !] 2 SECONDARY CONTAINMENT COMEONENTS ARE TESTED EVERY 36 MONTHS. ,90a- ® 3.SPILL BUCKETS.ARE TESTED ANNUALLY. VIII. RECORD KEEPING ,9M.0 Tic following monitoringmantemance records are kept for this facilir% ® a.AL.ARtsl LOGS ❑ b.\TSLT.L INSPEC I')N RECORDS ❑ u.TANK INTEGRITY TESTING RESULTS ❑ LSIR TESTING RESULTS(and supporting documentation rawrds) ❑ e.TANK GAUGING RESULTS(and supporting doeumenlation recmds) ❑ f ATG TESTING RESULTS(and supporting docaewanati(o records) ❑ g.CORROSION PROTECTION 60-DAY LOGS N EQUIPMENT MAINTENANCE.AND CALIBRATION RECORDS VL TRAINING ® Personnel with UST monitoring reaponaibilties arc familia with all of the following doeamentg relctant to their job duties: J9m69a REFERENCE DOCUMENTS MLIINTAINED AT FACILM(Check all that aWl) ®THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 9069E U ® OpER4TING MANUALS FOR ELECTRONIC h1ONITORING ROtTI MENT(Required) 9c- ❑ C UIFORNLA UNDERGROUND STORAGE TANG REGULATIONS 49oa9a ❑ l'ALEORNLA LTIDERGROUND STORAGE TANK LAW 49o-a9e. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: -HANDBOOK FOR TANK OWNERS - MANUAL AND 490s9[ STATISTICALINVENTORYRECONCDIATTON^ 49"ft ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS- 49069r ❑ OTHER(Specift): J90'm` This facility has a`Dvaignated UST Opemtar"who has passed the California UST System("aim Exam administered be the International Code Council (ICC). The "Designated UST Operator"will train facility cmployces in the proper operation and maintenance of the UST systems annually,and within 30 days of hive.This training will include,but is not limited b,the following: )0 Operation of the UST systems in a manner consistent with the facility's best management practices. ➢ The facility employee's role with regard to the monitoring equipnsent as specified in this UST Monitoring Plan. ➢ The facility employee's rote with regard to spills and overfills as specified in the facility's UST Response Plan. D Nsare(s)of contact persons)for emergencies and mortaring alarms. X. COMMENTSIADDITIONAL INFORMATION Rohde additional co is here or indicate how mane pages w' additional ada maken on specific monilmirg procedures are anached to Mi plaayn. J'"` r ©VAl- a XL PERSONNEL RESPONSIBILITIES The UST(:laser Operator is responsible fm emurng that: 1.)the daily rout,,,UST ram n,,ng activities and maintcaamce of UST leak detection equipment cohered this plea occurs 2.1 atl conditions;tha_I_ndiule a possrbk release are in,esligat d:and 3.)art moailoung rno[ds ae nuiotained properl)'. THE FOLLOWING PERSON(S)ARE SPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT TENANCE. NAME: 49on TITIE: 41.-, NAME: J:41 All-ei44907,. TITLE; J9i t The Designated UST Operator shag perform a moaddiv I wred uaspcetion o1 the t"Itn'.prnl ide a report to the ownm op or,and inform the ownm operator of ane conditions that need follow-up action. XII. OWNER/OPERATOR SIGNATURE CERTUTCATION:I certify1thrat the information pro ed herein is true and aceturate to the best of my knowledge APPLICANT SIGNA7LrRE DATE: h CVl \„ rx� aPPRPSENig,O 1TaoEtTrvs - -� 3.u°lomil exerimtlae of�mve 490'6 (� APP.I(:ANT (pint} m UOVA J9a-s APPLICANT 7777.E: Jur.-9 i /3 L UIPCF UST-D(12FIW7)-314 www.unidorsorg Arr. ,Q �� C?/z3f02(