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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDC MONITORING (Check all \" ) !)mta 11 UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) N 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490.54a. ❑ 4.NO DISPENSERS 0 99.OTHER(Specify) 490-54b LEAK MONITOR MANUFACTURER:veeder root 49a5S. MODEL#:TLS 350 R 490.56. LEAK SENSOR MANUFACTURER:veeder root 490-57. MODEL#(S):208,304 490-58. DETECTION OF A LEAK INTO TILE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. N a.YES ❑ b.NO 4m-w. UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. N a.YES ❑ b.NO 49a60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. N a.YES ❑ b.1\10 490-61. UDC MONITORING STOPS TiIE FLOW OF PRODUCT AT THE DISPENSER. N a.YES ❑ b.NO 490.62. UDC CONSTRUCTION IS: ❑ 1.SINGLE WALL N 2.D011BLE WALL 49043. IF DOUBLE WALL: 490-64a' UDC INTERSTITIAL SPACE IS MONITORED BY: N a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. N a.YES ❑ b.NO 00-60. VII. PERIODIC SYSTEM TESTING 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. LEAK DETECTION EL MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.123 CCR42M4.13 ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49046_ ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. 49°67. VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 49949. ® a.ALARM LOGS N It.VISUAL INSPECTION RECORDS ® c.TANK INTEGRITY TESTING RESULTS ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGNG 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 UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties: 490690-_ REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that appl)) N THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490696. N OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 49049.. N CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49069d. N CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-0.. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 49049( STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 49a69g. N OTHER(Specify): 49049h490491. N 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). 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. D The facility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. D Nume(s)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 are attached to this plan. 490-71. UST Designated Operator Training "Overfill Protection Method: ATG set at 90%of tank capacity" XI. PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that: 1.)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment cavered b this Elali occurs;2�a11 conditions that indicate a assible release are investigated_and 3)all monhoring records.are maintained pro nerl ___ THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: Alicia Pfeisle 490.72' TITLE;Aisle 1 Manager 490-73. NAME; Celia Wright 490-74. TITLE:Aisle 1 Colleague 490.75. The Designated UST Operator shall perform a monthly visual inspection of die facility,provide a report to die owner/operator,and inform the owner/operator of any conditions that need follow-up action. XII. OWNERIOPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 490.77' 711712009 REPRE6ENrINa: LTank Owned a®2. ecild•Oxmerl0 mmr❑3.AuthoruedA rcsenWive of Owner 490-76. APPLICANT NAME(print): 490-79. APPLICANT TITLE: 450-79' Paul Gianetto Sr. Manager Outside Sales UPCF UST-D(12200'1)-314 wttiv.uuidocs.org