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UNIFIED PROGRAM CONSOLIDATED FORI aa, UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING I. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 4m544 4msae 0-1. CONTINUOUS ELECTRONIC MONITORING ❑ 2. FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONE ❑ 4. NO DISPENSERS ❑ 99. OTHER(Specify): PANEL MANUFACTURER: 49a35 MODEL M: 4sasu LEAK SENSOR MANUFACTURER 49 57 1 MODEL M(S):LA L 4sa58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS Ja a. YES ❑ b. NO 49P59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a. YES ❑ b. NO 490c0. -R FAILURE / DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a a YES ❑ b. NO a9a.6r , UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER R&YEs ❑ b. NO 4mm 2. UDC CONSTRUCTION IS . SINGLE-WALLED ❑ 2. DOUBLE-WALLED 490b1 IF DOUBLE WALLED: amu. UDC INTERSTITIAL SPACE IS MONITORED BY: 0 1. LIQUID El 2. PRESSURE 0 3. VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a YES ❑ b. NO amus VII. PERIODIC SYSTEM TESTING 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED amus. MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1 . SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 4m66 3. SPILL BUCKETS ARE TESTED ANNUALLY. amort VIII. RECORDKEEPING The following monitoring/maintenance records are kept for this facility: JkrAlamin logs 490.6&, ❑ Visual Inspection Records 4m b ❑ Tank integrity testing results 4m & SIR testing results (and supporting documentation records). 49a.6gd ❑ Tank gauging results (and supporting documentation records). 49obge ATG Testing results (and supporting documentation records). 49 8f ❑ Corrosion Protection 60-day logs 4mug )ELI6quipmem maintenance and calibration records. 490 n DL TRAINING Perwnnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 4m % REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) S UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 4m % ,K-OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 490.69c Ll CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4m w ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490 v ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 490w1` ❑ SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" e9o.6vg ❑ OTHER (Specify): M6914 msA is facility has a "Designated UST Operator" who has passed the California UST System Operator Exam administered by the International Code Council (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: ➢ Operation of the UST systems in a manner consistent with the facility's best management practices D The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan L The facility employee's role with regard to spills and overfills as specified in the UST Response Plan 10 Names of contact person(s) for emergencies and monitoring alarms. 49 70 X. COMMENTSIADDITIONAL INFORMATION Provide additional comments here or indicate law pages information on specific monnitorin(g` procedures areattachedto this plan. 4sa7i ®many 1with `additional f [ XI. PERSONNEL RESPONSIBIUTIES The UST Owner/Operator is responsible for ensuring that: 1) the daily/mutine 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 followi n(s) are responsible for performing the monitoring and equipment maintenance: NAME 49042 TITLE `� P 490.73 NAME i �- 4m74 TITLE �� 49ors The Designated Operator shall perform m nthly visual inspection of the facility, provide a rt to the owner pastor, an inform the owner/operator of any conditions that need follow-up action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION: 1 certify that the information provided herein is we and accruate to the best of my knowledge. APPLICANT SIGNATURE amru DATE: ++0-73 nn ��1��` / t (/ APPLICANT NAME (print): J90.48 APPLIC TITLE: 490"79 UPCF UST -D (12/2007) 314