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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN— (Page 2 of 2 VL UNDER DISPENSER CONTAINMENT (UDC)MONITORING at 0-p as that a t UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 1.CONTINUOUS ELECTRONIC MONITORING El2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-540, ❑ 4,NO DISPENSERS ❑ 99.OTHERS ci 49as4b _............ . .......- - ......-- ._.. _......_....._.. ------- - ---—... .F$.- ) LEAK MONITOR MANUFACTURER: 4--.> 41111' MODEL#: 3 LEAK SENSOR MANUFACTURER: 2 r, 490.57. MODEL#(S): _ 490ss, DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL Ai,ARMS. a.YES ❑ b_NO 49059, UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN_ X,,YES ❑ b.NO 490.60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑ b.NO 490-61' UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. a.YES El b,NO a90-62. ----- ----- — -- - - •..--- ----- ---- _..._ - ---.._ ___.. _.._.... ._ ............ UDC CONSTRUCTION IS: 1.SINGLE WALL ❑ 2 DOUBLE WALL 491-60-. IF DOUBLA)MALL: 490-64a, UDC 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 490-64b, VTI. PERIODIC SYSTEM TESTLSTG 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. n MUST BE PERFORMED. PERIODIC BLD IS PERFORMED EVERY 36 MONTHS AS REQUIRED,p3 ccR :644.1 ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTER EVERY 36 MONTHS. 490-66. ® 3_SPILL BUCKETS ARE TESTED ANNUALLY. 49o-G7. VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 490-66. ® a,ALARM LOGS ❑ b.VISUAL.INSPECTION RECORDS ❑ c.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. TRAJNJNG Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: 491-690-. REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490-69b. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490-69c, ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49049d. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490(90, ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 490.69£. STATISTICAL INVENTORY RECONCILIATION" F1SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS- El 440-69h, ❑ OTHER(Specify): 490.691, ® This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the international Code Council 451-70. (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. 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 facility's UST Response Plan, D Name(s)of contact person(s)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide additional Comments hatro or indicate how many pages with additional inform tion on Specific monitoring pr eedurea are attara ted to this Ian, a9oai. iS 0 .� Q Ledaaajs XI. PERSONNEL RESPONS ILL IE The UST Owner/Operator is responsible for ensuring that: 1.)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered bX_this_plan occurs;2_)all conditions,that indicntc a.possiblc roleAse are.lnvestigatedt sod 3.�all monitoring rccords.are_maintain_ed Rropery................__.___._.___.___.__.__.._......... THE FOLLOWING PERSON(S)ARE SIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: Ci�`JGR-�`1. J.�i�A'' 490-72 TITLE! A Z yj � 0-v f/fa _490-73. NAME: 490-74, TITLE: 490-75. The Designated UST Operator shall perform a monthly visual inspection of the facility,provide a report to the owner/operator,and inform the owner/operator of any conditions that need follow-Lip action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify t t the information herein is true and accurate to the best of my knowledge. APPLICANT SIGNATUREDATE: 49D.77' REr�Rma[NTIh G' 1.Tenk Owner/Oneri� 2.Focilii Own -erni6r J.AWJ,0-,w-d 0-e c.nwi�eof0w 490-16. —2 —� V APPLICANT NAME(pri > 490-78. APPLICANT TITLE: 490-79. Z' A UPCF UST-D(12/2007)-314 www,unidocs_arg r0vd 80109SHOZi 'old M H SSHI WO Q00,d Ind ZZ : 10 Idd/HOUSIAH