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MAY -4-2009 07:45A FROM: P.3 <br />001200 <br />TJNIT1IhD MiOGRAM CONSOLIDATED FORM <br />UNVFXGROVND STORAGE TANK <br />MQTLAN - LAR02 pfd <br />VI. UNDUR 01-SPOSOX Ol!iTAINNMNT (UDC) -MONITORING <br />ra <br />UDC MONITORING IS PERFORM® USING THB FOLLOWING-MMTHOD(S) <br />, <br />❑ I. CONTINUOUS ELECmmc MONITORING 2. I9.OATAND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONE <br />mss" <br />❑ 4. NO D_LSPBNSIIIB __ ❑ 99.OTIRH! (Sppi�) <br />+s0 t+h <br />t.EAK MONITOR MANUPACTURiR. MODEL A: <br />r 01111 <br />LEAK SENSOR MANUFACTURHR: 4oasa MODEI•;1(ST <br />+oust <br />DETECTION OP A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. Q a• YES ❑ b NO <br />+sos2 <br />UDC LEAK ALARM TWOOERS AUTOMATIC PUMP SHUTDOWN. [] .,YES ❑ b NO <br />n�s'an <br />FAII[MISCONNECI'ION OF (IDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b NO <br />4e0d1 <br />UDC MONITORING, MPS TIM FLOW OF PRODUCT AT THB DISPENSER. ❑ a. YES ❑ b. NO <br />170411 <br />UDC CONSTRUCTION IS: JZ 1 SINGLE WALL ❑ 2. DOUHLE WALL _ <br />171167• <br />(F DOURL13WAU <br />4111144. <br />UDC INTERSTMAL SPACE IS MONITORED BY. ❑ o. LIQUID ❑ h PRESSURE ❑ c. VACUUM <br />A LEAK WffHTN THE SOCONDARY CONTAINMENT OF THE UDCIMGBRS AUDML8 AND VISUAL ALARMS [J s. YES ❑ b, No <br />a00�d <br />+ I' dW "1%M S'-ING <br />I. 61,D ITSTIN0: THIS PACIWTY HAS 8E13r4 NOTIMED BY THE STATE WATER RESOURCES CONTROL BOARD THAT H_U ANCED <br />MUST BE PERFORMED. PERIODIC QLD IS PERFORMED EVERY 36 MO IS AS RUQ2lRaD. in ccs {7644.11 <br />® 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. <br />+ <br />® 3. SPILL BUCKETS ARE TESTED ANNUALLY. <br />19041' <br />VIP. 13 C0ph r/1nYnn IN <br />'rhe following monitorinwirla,n quince retorts ate keps for this facility. <br />4011611 <br />a. ALARM LOGS b. VISUAL INSPEC770N RECORDS [] o. TANK INTEORITYTESTINGRBSULTS <br />d. SIR TESTING RESUL (and aupponing doctmtentatttn records) ❑ e. TANK OAUGINO RMULTS (and supporting dacwttmnatino retards) <br />❑ f ATOTEMO RESULTS (and supponlog dor rnicinstian (cants) ❑ B. CORROMON PROTECTION 60 -DAY LOOS <br />h. E UIPMENT MAINTENANCE AND"CALIBRATION RECORDS <br />M � <br />Pasmmd with UST monitoring responsibill p etc fDsmt m with oil of ilio following docmnasts relovaot to thcir job "as: <br />+0066. <br />REFERENCE DOCUMENTS MAINTAINED AT FACILITY (ICkeek all roar apply) <br />® THIS UNDF.ROROUND STORAGE TANK MONITORING PLAN (Required) <br />+� <br />® OPERATa40 MAKUALS FOR ELECTRONIC MONUORINO EQUI?MMfr (Scgntred) <br />4vsbz <br />❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS <br />490,69e. <br />O CALIFORNIA UNDERGROUND STORAGE TANK LAW\ <br />49MK <br />C] STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUW7 rON: "HANDBOOK FOR TANK OWNERS MANUAL AND <br />004%. <br />STATISTICAL INVENTORY RECONCILIATION' <br />❑ SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK OAUGINO'SYSTEM4" <br />190'Q9s <br />❑ OTHER (Specify} <br />Iwo <br />+70.674. <br />Thi: facility has a'Dasigaated UST Opwmtaf' xtho has paswd Alto Callfomis UST Srwrn Operator Exam adinintstored by" Iotornatiorml Code Council +'11.10 <br />(ICC). Tito "Designated UST Operator" will train facility employcea in tho proper operation and mamtenince of the UST systems annually, and within 30 <br />dogs of hire This (raining will iacludo, but is not limited to, tho following: <br />D Operation of tiro USI• systems in a manner consisnW with the facility's best manngeltwlt pmchcas. <br />y Tho fadlity employco's rolo with regard to tho rnonitoring equipmont as spoeifed in this US'T Monitoring Plias <br />A Tho facility, employee's role with rtgird to spills and overfills as specffied in the facility s UST Rcsponse Posit <br />Name(a)ofeonmactperson(a)foremorgenoiosaxrtdrrnya�nitorrinngullaffnss� <br />C�iC[dVi�ita'1 �7/SM[l/4R� 74 t.F14 1'1iJ4� <br />Provi D alinasal commune aro err iiteioaro !ww ruithy WA Wits) additional Infort n oil aped fie monieorlog pirneedureq am attached to this pMn. <br />Wit <br />XI. LR90NN'�L,i�E8YON31DIY.I � <br />Tho UST O%tcr/Opmartor is responsible fair ensuring that. I•) the daily/routlsta UST iNniooring activities and matntonsnoaof UST leak detection equipment covered <br />by this plan o0cmfC 2,) air ODndfdOn9 that iMUea10 n PDs9lble Yt1e49eYre IrrVeStt akdi and S.)-i1t 'tp MaiDtnitu!d [,—q? y <br />TMH POLLOW[No PER (S) ARE RESPONSIBLE FOR PIs3tFORMINGTN1bMONTTORTNG AND EQUIPMENT MAINTENANCE <br />NAME; _ O L" h� �(� TITLE: ) a ✓� dam( <br />+ears <br />NAME. 4W4, TI JR <br />4y0rs. <br />The Dw(sphted UST Operator Mail perform a monthly vfsusl fnapectfos of the4aC1 try, provido a report to Rho owner. opesstor, and infitem the owner/operator of arty <br />condiliona that raced follerm-ols ictioa <br />XM (ftVATtI1kMGNA T[JItF <br />CERTWICATION: I entity that The information prgAded Wefu4s "a land accurate to Alt but of my knowledge. <br />APPLICANT SIONATURB <br />DATE;Rislitm <br />'9O rr <br />Plrra`il Q I. Tad Commr ?. � " t rn ler ]. Au � nail .o•rA <br />APPLICANT (grisly <br />APPLICANT TITLE: <br />i9 119 <br />' <br />UPCF UST -D CIIJZM V4 r www.uatdtacs org <br />