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IiN1FI£D PROGRAM CONSOLIDATED FORM <br /> U,NIDERGROUND STORAGE TANK <br /> MONITORING PLAN — (Page 2 of 2) (('heck m`1 <br /> VI. UMONITORING that a rte; <br /> UNDER DISPENSER CONTAINMENT (UDC) <br /> ___------ <br /> UDC'MONI'iORI*+G N PFRYOR,rvtED USING 7 HL F()I.L��1tiG MfT}IOD(S 1 3.El.FC TRUNJC"ST.ANI}A1.UtvF. <br /> OU.S ELECTRONIC MONIT01U. 2 FLOAT AND CHAIN ASSEMfii.1 ❑ <br /> I'�1 CONTINU <br /> i C1 ---- eQ • _ Zo'r °`'S`" MOI)ll b SLS -�5 <br /> .vu- <br /> t <br /> 4 NO UlSPENSIR, 9a OTHER(SPfi .o.ss <br /> LEAK M0141!-ORMANUFACTVRER. <br /> MODEL'»S) R�— <br /> '�a YES [1 h NO <br /> LEAK StiNSt)}t VLti\L,F AC l 1: TH�_F F MBLE ANI)VISUAl. .ALARMJS 411 <br /> DETECTION Of A LEAK INTO TIiL LilX TRIGGER AU r NO <br /> a YES . <br /> UDC I.I:AK ALARM TRIGGERS AUTOMATIC PUMP SHI TDC)WN a YES ,n, ! '*o <br /> 1 b Nt! s9o-a: <br /> FAIL-PEDISC ONNECT7ON OF UZ)i'MONITORINti SYSTEM TRIG{;ERS AL;TO.'vL4TIC t'I.'�7P SHt ltk)u N a YES <br /> C <br /> 4%,6- <br /> Ulxy MONITORING STOPS THE FT.O\k t)1 PRUDL(CT AT THE DISPENSER - <br /> S[NGI f,WA]I <br /> UDC'CONSTRL`Cn0N IS <br /> i. .vrw= i <br /> h PRESSURE (] : V,4CLit1M NJ .a}nae <br /> IF DQU�ALL a YES ❑ b <br /> t.'DC I-NU'ERSTITTAL SPACE IS MONITORED HY ❑ a L1QUlC! <br /> A LEAK w7"CtifN TFfF:St:CONDARY 1:0N'I MNMEI I Ol l-FfE LDC TRIGGERS Atj-DI13L:AND VISUAL ALARMS ❑ <br /> VII. PERIODIC SYSTEM TESTING N FD 49"- <br /> __ WATER RESOI.IRCF.S CONTROL BOARD TNA t C .''moo 00 <br /> 1 ifs TESTING. TIIIS FACILITY HAS BEEN NC)T IFiED BY THE STATE <br /> ON . MUST'BE PERFORM-," PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED <br /> —__---- 4�9U�7 <br /> ® <br /> -,,.SECONDARY CONTAINMENT COMPONE TS ARE TESTED EVE RY 36 MONTFIS. — —� <br /> ® 3 SPILL BUCKETS ARE TLS ED A vNLL0.LLY VIII. RECORD KEEPING 4yo s>s <br /> I monttcxmg•maintmance records are kept for tills facility. <br /> The following c.TANK INTEGRITY TES'ITNG RESULTni dcxlrmontauon rnconls) <br /> ® a ALARM LOGS ❑ b VISUAL INSPECTION RECORDS 0 e TANK GAUGING RESULTS(and supporting <br /> ❑ d SIR TESTING ItI SULTS land supporung documematton retards CORROSION PRO'fECT1()N 60-DAY LOGS <br /> ❑ f.ATG TESTING RESULTS(and supporting documerttauon records) ❑ B —I <br /> n E UIPMENT MAINTENANCE AND CALIBRATION RECORIX TRAINING <br /> Personnel with UST monitoring responsibilities are familiar with all of the following <br /> documents relevant to thea job duties: .9o-age <br /> 'EFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apPlr) 490 69c <br /> THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 4Wj-69d <br /> OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) .yr nvC <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS <br /> "90-6'9f <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW <br /> ROL BOARD (Sw'R(. <br /> STATE WATER RtSOtIRCES CONTH•4 <br /> PUBLICATION. ' NDBtx)K FOR TANK OWNER` MANUAL AN awevn ; <br /> I ❑ STATISTICAL INVF•'NTORY RECONCILIATION• NK GAUGING SYSTEMS'- tare�n ' <br /> I [] SWRCB PUBLICATION "UNDERSTANDING AUTOMATIC TAsaa+o <br /> ❑ OTHER(Specify). the California UST System Operator Exam administerd In•the Internailona Code Cainn3ii <br /> This facility has a"Designated USToperator"who has? tion acrd maintenance of the[IST systems annualh,and within 30 f <br /> (ICC). Tice "Designated UST Operator•Will train facility employees in the Proper opera <br /> days of hire.This training will include,but is not limited to.die"low-Ittg. practices <br /> ➢ Operation of the UST systems in a manner consistent with the facility*s best ft ed in this Monitoring Puri <br /> j ➢ <br /> The facility employee's role wtith repaid to the niartitnrtng egwpment as <br /> •n the faciltty's UST Response Plan <br /> ➢ The facility employee's role with regard to spills and ove�il,as spx ----- -- r_ <br /> � Nen*s)of contact personts)for emergencies and ntonitoting alarms <br /> X. <br /> COMMENTS/ADDITIONAL INFORMATION 4W.1.71vlw h d to this svuer� F kI�>i <br /> [( �r �pw pcs with" iii9nal inform i on specifK y�;vt" t1 E rL <br /> aPhoVT� it�ito� Vi tldFNBtJt ,�t=ASE iS S[:tJCrr� r� TtNi tN� j <br /> t U SIBILITIES <br /> XI. PERSONNEL RESP + covered <br /> ce 01 <br /> The UST Owner/Operator is responsible for ensuring that <br /> leaseaare mvuestigat d,and 3t)all niworing rmg ar`'cordsnd tare mainntained propertdetectitm equ2p ! <br /> by_this plan oci:Ws,2}ail conditions dmt utdicatc a poi _-- AND <br /> THE FOLLOWING PERSON I ARE RESPONSIBLE FOR PERFORMi HT1 LT:1��IT�N T MAINTENANCE <br /> NAME J A�oi,l F �' +x.r. TITLE M Errptrat or o <br /> NAf anNAIL K rr1 N to the o%%=r;operstor.and inform the <br /> owe:-� <br /> The Designated UST Oper <br /> ator shall perform a morAhl. visual 111Iof the facilit).r'rovi' a r>ptxt <br /> condtnons that need folio_+•- action <br /> XII OWNER/OPERATOR SIGNATURE <br /> CERTIFICATION-I eertif� that the information rovidcd herein is true and accurate ttAe best of mN.knaN Ied c• <br /> A t"PLIC.ANT SIGNATLiRF 1 /2- l 1 Z <br /> amine rf f?»ner �qr7r k <br /> .gha•m^. �w'3 tITi.F. <br /> .,,,•PRMFNt7111, ❑1 TV11 U."'0 i,� Feniin til ra ecu: .,\PPL i.(:.4NT T <br /> I APPLICANT NAME(printf <br /> ..w1..unidncs.orV <br /> LiPCF UST_D([2/2000-3A <br />