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'010 07:15A FROM: TO:12094683433 P.2 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) Vt.UNDER DISPENSER CONTAINMENT(UDC)MONITORING -` 490.544 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 49044b ❑ 1,CONTINUOUS ELECTRONIC MONITORING 'X2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELEC'T'RONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.0THER S i 490-55 PANEL MANUFACTURER: MODET.#: 490.56. ---- --------------------•___•.. ...------------- LEAK SENSOR MANUFACTURER: 490'57 1 MODEL#(S): 490-58 DE'T'ECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES t4b.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES Pb.NO 490.60. FAILURE I 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 ❑b.NO 490.62 2.UDC CONSTRUCTION IS 1%1.SINGLE-WALLED ❑2.DOUBLE-WALLED 490-0 IF DOUBLE WALLED: 490-64& UDC INTERSTITIAL SPACE IS MONITORED.BY:_OL—LIQUID ❑2.PRESSURE ❑3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a-YES ❑b.NO 490'", 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(ELDI MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR§2644.1) -- $12.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490.67 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: �Alarm logs 490.68& Visual Inspection Records 490686 ❑Tank integrity testing results 490-68e ]SIR testing results(and supporting documentation recards)_ 49e.68d ❑ Tank gauging results(and supporting documentation records). 490.680 ❑ATG Testing results(and supporting documentation records) 490.68f ❑ Corrosion Protection 60-day logs 490689 Equipment maintenance and calibration records. 49M81i IX.TRAINING Personnel with US'r monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 49069& REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490.69b OPERATING MANUALS FOR ELEC'T'RONIC MONITORING EQUIPMENT(Required)490690 CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49o-m ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490.690 ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND S'T'ATISTICAL TNVENTORY RECONCILIATION"49OW ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490.699 ❑ OTHER(Specify):M69h M69i This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(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 trot limited to,the following: A 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 to this UST Monitoring Plan D 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.49o-7o X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how marry pages with additional information on specific monitoring procedures are attached to this plHn 490.71 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 covered by this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The following person( are res nsibl��performing the monitoring and equipment maintenance NAME /-� 490-'2 TI-I LE ago-77 NAME; 490-74 TITLE 490-75 The Designated 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-up action. XII.OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the inform 'on provided herein is true and accurate to the best ofmy knowledge. 490-77 APPLICANT SIGNATURE 490-76 DA'I S: 440-711APPLICANTTITLE490.79 APPLICANT NAME( rint): >bJc. '5,.,� t Zy,2r" W�...,.•i' �•,jiY7r.4.-4-'�`�1 /T�— 1 urcF UST-D(12f2007)3ra ,�� /Jlb A(/'o r � —y