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• • UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN—(Page 2 of 2 VI.UNDER DISPENSER CONTAINMENT'(UDQ MONITORINGthdr lj UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ® 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54a ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) ago-sab. LEAK MONrrOR MANUFACTURER Veeder-Root 490.55 MODEL d:TLS-350 49a56. LEAK SENSOR MANUFACTURER BeaudreauR 490-5/. MODEL tl(S):406 490-5a DETECTION OF A LEAK UNTOTHE UDC TRIGGERS AUDMU AND VISUAL ALARMS. ® a YES ❑ b.NO 490'59' UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a YES ❑ b.NO 49040. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑ b.NO 49"" UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ® a YES ❑ b.NO 49042 UDC CONSTRUCTION IS: ® 1.SINGLE WAIL ❑ 2.DOUBLE WALL 490.63. H DOUBLE WALL: 49044` LTDC 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 490"6.tb. \'II PERIODIC SYSTEM TESTING ❑ L ELD TESTING- THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD "THAT ENHANCED 490"es LEAKPLTECTION(EELDI MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.I23 CCR 9arvt4.11 21 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49046. ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-67. VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 490-08' ® a.ALARM LAGS ❑ b.VISUAL.INSPECTION RECORDS ❑ a TANK INTEGRITY 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 IX. TRAINING ® Personnel with USTmomturingresponatbditics are lhmiliarwidt all oflhefollowingdocuments relevautto 0reirjob duties: +9069a REFERENCE DOCUMENTS MAINTAINED AT FACILITY(/:'heck all iliac apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 49049b. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490.69a ® CALIFORNIAUNDERGROUND STORAGE TANK REGULATIONS 490-69d ® CALIFORNIA UNDERGROUND STORAGE TANK LAW 49049°. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: `HANDBOOK FOR TANK OWNERS - MANUAL AND 49049E STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 49049s. ❑ OTHER(Specify): 490494` 490491 This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 490'70. (ICC). Ilia "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,bat is not limited to,the following: ➢ Operation of the UST systems in a manner consistent with the facility-s best me®gement practices. Y The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan. Y The facility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. Y Name(a)ofenntacl paeon(s)far emergencies and monitoring siartne X. COMMENTS/ADDITIONAL INFORMATION Provide additional cormneuLc here or indicate how many pages with addhionm infonnmon on specific m.nit.mg proved es are atmched to this plan_ '1)0"'t Overfill : OPW 61 Overfill Droptube Set @ 95%shut off XI. PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that: l.)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered b thisPlnn occurs;2.)all condition that indicate a possible mt9aaa ore mvevd�ted;and 3.)alt monitoring records aro maintained propady. THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: 490'"+2 TITLE:Facilities Manager °90-J3. NAME: Kevin Selby 9 NAME: Doug Duboce °9ar0. TITLE:Designated UST Operator 49°'75. The Designated UST Operator shall perform a monthly visual inspection of the facility,provide a report to the owner/operator,and inform Ilse owner/operator of any conditions that need follow-Lip action. XII."OWNER/OPERATOR SIGNATURE-' CERTIFICATION: I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 490"77 „ 6/1/2011 rePacssnrmo:O t.rwc 2 P99aay 3.a,aboimA s 9ro«ae: 49o-06. APPLICANT NAME(prim): /� . APPLICANT TITLE: 490-]9. E r sCa A L /! ” d i rr /Hdwur. dy' UPCF UST-D(122007)-3/4 rrww.eaddoes.org