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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN—(Page 2 of 2 Vt.UNDER DISPENSER CONTAINMENT(UDC)MONITORING rr - 112111 aYYI)9 UDC,MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ® 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) 490-sqb. LEAK MONITOR MANUFACTURER:Veeder-Root 49°35' MODEL d:TLS-56 490-56 LEAK SENSOR MANUFACTURER BeaudreauK 490.51' MODEL ff(S):406 wo511. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ® a.YES ❑ b.NO 490-59' UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a-YES ❑ In NO w9-6o. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑ b.NO UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER ® a.YES ❑ In.NO 49x61 UDC CONSTRUCTION IS: ® 1.SINGLE WALL ❑ 2.DOUBLE WALL wa6x IF DOUBLE WALL worm. UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a LIQUID ❑ In.PRESSURE ❑ c.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO dM-64b. VIL PERIODIC SYSTEM TESTING ❑ L EI.D TESTING: THIS FACILTIY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED -0 5- LEAK D TECTION ff!M MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.hJCCR g2a44.q ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 4906a ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. 49asT. VIII:'-RECORD KEEPING The following monituring/maintenance records are kept for this facility: 490 sx. ® a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ G TANK 1,TEGRIIY TESTING RESULTS ❑ d.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 ® h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS _ ;LY. TRAINING ® Personnel with UST monitoring responsibilities are familiar with all ofthe following documents relevant to theirjob denies: g9ofi94. REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that appy) M THIS UNDERGROUND STORAGE TANK h10NITORING PLAN(Required) 490<9b. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 4so69o. IM CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 40b9d ® CALIFORNIA UNDERGROUND STORAGE TANK LAW 4sOs9 ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 19 9f STATISTICAL INVENTORY RECONCILIATION" ❑.SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490 . OTHER(Specify):Procedure written and training for use of waste oil tank 9oas This facility:-'s a"Designated UST Operator"who has passed the Glifamia UST System Opara]or Etmm administered by the Lrtemafional Code Council 490'0. (ICC). The "Designated UST OpermoT will train facility employees in the proper operation and maintenance ofthe UST systems annually,and within 30 days ofhire.This training will include,but is not limited to,the following: ➢ Operation ofthe UST systems in a rammer 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. > The facility employee's role with regard to spills and overfills as.pec flied in the facility's UST Response Plan. D Name(s)ofcontact person(s)fm emergencies and monitoring alaxon& X. COMMENTS/ADDITIONAI3NFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are atreal ed to this plane. 490-11. Overfill:OPW 61 Overfill Droptube Set 95%shut off XI. PERSONNEL RESPONSIBILITIES The UST Ouner,'Operator is responsible for ensuring that:1.)the daily/routine UST monitoring activities and nuinterau ce of UST leak detection equipment covered by this plan occurs,2.)all conditions that indicate a possible mime we investigated;and 3.)all monitoring records are maintained properly, THE FOLLOWING PERSON(S)ARE RESPONSIBLE.FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME; Kevin Selby 490-7. TTTLF:Facilities Manager 490.73. NAME: Doug Duboce 49074. TITLE:Designated UST Operator /90-95' The Designated UST Operator shall perform a monthly visual inspection of the facility,provide a report to the owner/operator,and inform the mover/operator of any conditions that need follow-up action. XII: OWNEWOPERATOR SIGNATURE'' CERTIFICATION:I urtiry that the information provided herein is true and accurate to the best of my knowledge APPLICANT SIGNATURE (, DATE: dean. 6/1/2011 REPRESEMING:O 1.Tank 490-76 APPLICANTNAME(prim): . / 490-'a APPLICANTTITLE:. wo79. UPCF UST-D(1212007)-3/4 wrrw.mridoo.otg I� 1