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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK NIONITORIN'G PLAN' (Page2of2) - VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 490.54a 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54b ❑ 1.CONTINUOUS ELECTRONIC MONITORING 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE � ❑a.NO DISPENSERS 099.OTHER(Specify): ---•--- ..................... — - — ------ - -- --—_— --------- -- —— - --r- - -4: -- ,n-56 MODEL#: PANEL MANUFACTURER: __ _ -------- -' ------------------------------------ — LEAK SENSOR MANUFACTURER: — t2 MODEL#(S): _ J Ii 9 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES b.NO } ,-6u UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a.YES ❑b.NO n 4%t-61FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES NO - a.YES b.NO 4x1-6+ UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. 49t),-63 2.UDC CONSTRUCTION IS SINGLE-WALLED [12.DOUBLE-WALLED _ -- axt-taa IF DOUBLE WALLED: r PRESSURE 3.VACUUM UDC INTERSTI'T'IAL SPACE[S MONITORED BY: ❑ 1.LI UID ❑-.__---U— C3______--__--____------------------------ - — -•-•4b Q--___ _ J4glfi�b A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES b.NO VII.PERIODIC SYSTEM TESTING ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 4%4,5 LEAK DETECTION(FEDI MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. CCR§2644.1)_. -_.---.: -------------_ ---- -- ------- -- 490.6,6 �—2.SECOND 1RY CON`TAI;NMENTCOMPONENTS ARE TESTED EVERY 36 MONTH _ _ — -- - — a9o-r,7 3 SPILL BLICKETS1ARE TESTED ANNUALLY — — — -- VIII. RECORDKEEPING jTefolowirllg monitoring/maintenance records are kept for this facility: Alarmlgs 190.68a ❑Visual inspection Records 490-68b ❑Tank integrity testing results.t9u-c%� I SIR testing results(and supporting documentation records). ax>-6ad ❑ Tank gauging results(and supporting documentation records). 490-68C ❑ATG Testing results(and supporting documentation records).49L68r ❑ Corrosion Protection 60-dav logs 4w-68e Equipment maintenance and calibration records. axi-vsh IX.TRAINING E�Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-0:1 REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) - I THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)4xx.9b OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)aw-&)C i CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4x,-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"4w*w ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"4x-696 ❑ OTHER(Specify):M69h M69i This facility has a"Designated UST Operator"who has passed the Califomia UST System Operator E;am administered by the international Code Council(ICC). It" e"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 I 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 `r 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 specified in the UST Response Plan > Names of contact person(s)for emergencies and monitoring alarms.49(i-m X. COMMENTS/ADDITIONAL INFORMATION J Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.4xi-71 ONSIBSXl. RSONNEL RESP The UST Owner/Operator is responsible for ensuring that:1)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered by this plan occurs.2)all conditions Utat indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The following person(s)are responsible for pelforming 1}te monitoring and equipment maintenance 490-73 �J ct, �v 9- K- E aw r_ TITLE ✓� l; 490.7-1 TITLE he esignated Operator sha I perform a monthly visual inspection of the facility, provide a report to the o++ner/operator. and inlorm the owner/operator of any conditions that need follow-up action. XII.OWNER/OPERATOR SIGNATURE CERTIFICATION:1 certify that the information provided herein is t and accurate to the best of my knowledge. 4W-77 APPLICANT SI TU E �x>76 DATE: ) �- RF IiSr:N I i I Tank O,,ner! c tnr 1 faa n. ��nec0 emmr Amhorii:--d Re ra au�e (049-7% l 11%i 79 APPLICANT NAME(print): APPLICANT TITLE=: UPCF UST-D(12/2007)3/4