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UNIFIED PROGRAM CONSOLIDATED FORM ' UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VL UNDER DISPENSER CONTAINMENT(UDC)MONITORING 490.548 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54b ❑ 1.CO US ELECTRONIC MONITORING '%2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPEN ❑99.OTHER S ): PANEL MANUFA TURER 490 s6. LEAK SENSOR ACTURER: 490-57 i MODEL#(S): 490-5e DETECTION OFA INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a YES ❑b.NO 490-59 UDC LEAK ALARM TRI ERS AUTOMATIC PUMP SHUTDOWN ❑ a YES ❑b.NO 490-60. FAILURE/DISCONNECTI OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a YES ❑b.NO 490-61 UDC MONITORING STOPS FLOW OF PRODUCT AT THE DISPENSER ❑ a YES ❑b.NO 490-62 2.UDC CONSTRUCTION IS 1.S LE-WALLED ❑2.DOUBLE-WALLED 490-63 490-64a IF DOUBLE WALLED: UDC INTERSTITIAL SPACE IS MO RED BY: 1.LIQUID Q 2.PRESSURE 3.VACUUM A LEAK WITHIN THE SECONDARY CO AINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a YES [I b.NO ago 64b VIL PERIODIC SYSTEM TESTING ❑ 1. ELD TESTING. THIS FACILITY HAS BEEkNOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED ago 6s. LEAK D MUST BE PERFQRW. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS ASREQUIRED- 23 CCR 2644.1 2.SECONDARY CONTAINMENT COMPONENTS TESTED EVERY 36 MONTHS. 4�_ 3.SPILL BUCKETS ARE TESTED ANNUALLY. ago 67 RECORDKEEPING The following mon itociog/mau tenance records are kept forthis fa . cil $�Alarm logs 49D-6u ❑Visual Inspection Records ago Gab ❑Tank integrity testing results ago bac ❑SIR testing results(and supporting documentation records)_ ago-ad Tank gauging results(and supporting documentation records). 490-68c ❑ATG Testing results(and supporting documentation records).490-her Corrosion Protection 60-day logs 490-ag REquipment maintenance and calibration records. 49m a UL G Personnel with UST monitoring responsibilities are familiar with all of the follNdboatply) ments relevant to their job duties. 49069& RENCE DOCUMEN'T'S MAINTAINED AT FACU ITY(Check allTHIS UNDERGROUND STORAGE TANK MONITORING PLAN(Req9b OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPquired)49"9c CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4 ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49o4ge ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"49o-69r ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYS S"490-ft ❑ OTHER(Specify):M69k M6gi This facility has a"Designated UST Operator"who has passed the California UST System Exam administered by the International Code Council(ICC). The"Designated UST Operator"will train facility employees in the proper operation and maintenance 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 Monito 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.ago-7o 3L CON'IIVIENTS/ADDMONAL INFOtl� TIO Provide additional comments here or indicate how many pages with additional information on specificringare attached to this Plan-a90 7r �T 1 q S XL 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 follow" pe n(s) responsible for performing the monitoring and equipment maintenance: -, '^ NAME r n 490-72 TITLE 4f_i \ 490-73 NAME 4go-74 TITLE 490-75 The Designated Operator shall perform a monthly visual inspection of the facility,provide a report to the owner/operator,and inf ' the owner/operator of any conditions that need follow-up action. _ XM OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. — APPLICANT SIGNA'� 490-76 DATE: 49.0-717 REPRESEMING: 1.Tank OwnerlO tutor 2.Favi m Qmm_uJ0NmtDr rl 3.Auth2nwd R r e tativ_e of Ov -- 490.7$ 490-79 APPLICANT NAME rtnt): APPLICANT TITLE: