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I UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN — (Page 2 of T VI. UNDER DISPENSER CONTAINMENT(UDC) MONITORING (Cheek ail that UDC MONITORING IS PERFORMED USING THE FOLLOWING METHODS) ® i.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490.54 ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) °°0.54 LEAK MONITOR MANUFACTURER:Veeder ROM °90.55 MODEL M:TLS-M °90 i6 LEAK SENSOR MANUFACTURER:VOOder ROM °90.59 MODEL g(S):791390-208 490.56 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ® a.YES ❑ b.NO 4"" UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ e.YES ® b.NO 490""0 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a YES ❑ b.NO 19081 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ® a.YES ❑ b.NO asoar UDC CONSTRUCTION IS: --0I.SINGLE WALL ❑ 2.DOUBLE WALL ,was IF DOUBLE WALL: 4W61e UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO 49h VII. PERIODIC SYSTEM TESTING L ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS RE UIRED.123 oat PW 1 ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. °99dr VIII. RECORD KEEPING The following monaming/maintenance records are kept for this facility: aw-Oa ® a ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS ❑ it SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) ❑ f ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS 19 h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAIMNG Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties: ,wLb4 REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 49 % ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 4soe9r ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 417 %i ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 4a0^9' ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 49a�6q' STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 190"99 ❑ OTHER(Specify): ,seam oar as Thu facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the Intematirmal Cade Council 490.t0 (ICC). The "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. Y Operation of the UST systems in a manner consistent with the facility's best management practices. Y The facility employee's mle with regard to the monitoring equipment as specified in this UST Monitoring Plan. I- The facility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. D Names)of contact person(s)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures am attached to this plan '9an Ball floats are set at 90%of tank capacity to prevent an overfill. XI. PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible ha ensuring thin: I )the daily/routme UST monitoring activities and maintenance of UST leak dr esuion equipment covered b)this plan occurs.2.)all conditions that indicate apossible release are investigated,and,3.)all monnoring_tecords are maintained-properly. "THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: Shelly Jones 499'12 TITLE:Manager °90.r5 NAME: Sandy Edwards 490.1 TITLE:Environmental Compliance Administrator i90.t1 The Designated UST Operator shall perform a monthly visual inspection of the facility,provide a repot to the owner/opermor,and inform the owner operator of any conditions thin need follow-up action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION: I certify that the information provided.herein is true and accurate to the best of my knowledge. APPLICANT SIGNATUR I DATE: d s 617/2011 REFIT Wrol O ®1 Tint 2.F¢ii Owrar r &ahooWlt eenniss of Owner ,9prn UPCF UST-D(tiatw7 -4l/ www.ualdocs.org