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--C,4n M PROGdtw CONSOUDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN—(Page 2 Of 2 �.R�G qtr UDC MONITORING IS PERFORMED USING IM POILOWn4lM""(S) 3 ELECTRONIC STAND-ALONE 490 say. i.CONEiNUOUS ELECITtONIC MONITORDIG ❑2-RAAT AND CHAIN ASSEMBLY [3 3- 5*. ❑4.NO DISPENSERS Q 99-OrIHER(SPecli9) 49asa �wa5- MODEL#:-T C MS42 �^� LEAK MONITOR MANUFACTURER 'Y n C n — a9o-s1. P _U i S 49o.sa LEAK SENSOR MANUFACTURER: r n gO_c� _ MODEL d{Sj_G�_ DETDCTION OF A LEAK INTO THE UDC T'RK3GrFdt3 AUDIBLE AND VISUAL ALARMS- W a.YES [] b.NO 490-59. UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. +� Ill ❑ b.NO 49o4t- FAQ�Jp�TTNE•CI'ION OF UDC MONITORING SYSTIId TRIGGERS AUTOMATIC PUMP SHUTDOWN. 0 a.YES ❑ b.NO 491 a R YES NO UDC MONn-mN(I STOPS THE PLOW Oar PRODUCT AT THE DISPENSER 49043. UDC IS: I-SINGLE WALL 0? DOUBLE WALL 49064& IPDOLI ! Wim: c_VACUUM UDC INTERSTITIAL SPACE IS MONITORED BY [3a LIQUID ❑}' a YES ❑L NO4b' A TiiE SIsCONDARY CONTAit+IIvlENi QF THEvM1 UDC TIZIGGERS AUDffiLE AND VISUAL ALARMS. . ' 49obs. L gp 7H1.4 F1lt'gd1Y HA5 SEEN NO iII'ffiD BY TIS STATE WATER RESOURCES CONTROL BOARD THATiANtO D _ MUST BE PERFORMED.PE UMCELD IS EVERY 36 MONTHS AS UIBED. CM§2644.11 49066. ®2.SECONDARY CONTAII&IINr COhdi'013ENTS ARE TESTED EVF3TY 36 Mme- 491147. ® 3-91M dUALLy- _. . . . • -: .:. ' T6t "uwlogmonitotingrmaiSWMCeteooEdaaCWftt8trsfatality b.VISUAL SECTION RECORDS ❑c TANK INTEORI fYTESTING RESULTS ®a ALARM LOGS ❑ e.TANK GAUGING RESULTS(and saWortim8 docnmenfation records) ❑d.SIR TESTM RESULTS(ad supporting doctnne atiou re OT&ds) E]1:3£ATG TESTING RESULT(�mPPeB dxttmers uation records) ❑g.CORROSION PROTECTION b0 DAY LOGS .K WOUENATCEANDCALISRATiONRECORDS Pcrsormd wi&UBTmo Ralifwan fannlitrrvrrth all ofdre followmg documents relevant to tbeir job ditties: ROWM4CE DOCUMENTS MAINTAMD AT FACII 2'(Cbeckv l bwt 4WY) 490-M 10 THIS UNDERGROUND STORAGE T,M MONITORING PLAN 1("sel 490490. ®OPERATING MANUALS FOR 0,Ef;,Z7IONIC MONITORING EQUIPMENT(R«tvI 49069d. 0 CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS ~a []CALIPORNIA UNDEILUROUND STORAGE TANK LAW ❑STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION_ "HANDBOOK FOR TANK 01�RJIItS MANUAL AND 490,W- STATISTICAL INVENTORY RECONCILIAMON" 09069& ❑SWRCB PUBLICAMOTL•"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490— 49a49t ©OTIiFst(Speafyr Exam adnriaist by the National Code Council 490.10. ®T6ls fac8ity has a"Designated UST Opeotm,who Iles passed Califs a UST System Optta6or" and within 30 (I� The-D,4gO�d UST Operator'will train fadlity emPloyces in the P� pera otron and maintenance of the UST systettss annuatl y, days of hire.This ftWiag will include,bin is not limited to,the fullowing y Operation of fife UST systll in a mariner wnsutetrt with the facility's best rt�n 6--tit practices. Plan The fncrlity employee' regardMnthis UST Mnnitormg s rok with ib tlrc moni[arntg egaipmcut as specrfrod. Tire fapli{y employee's-I-- (h-garde spills and overIIls as specifn d in the facility's UST Response Phan. D Hamel efca 1pumu(s)fore cksandmonttoringaianus. 3 rRM�TIPN. 4-71 ProvideadrSAerd hwariadicate how maaY Pates vrRb additional information oa saeeifrc monill 1Omaum arc attached to thEc piaIt n. Ll et -�: �D ►; �z ...:. _..._. on em coo g Etat 1.)the dailyhoaDcu UST trtoairorieg aWvthes and> e°>pro°of UST leak deter equipment erect Tito UST OW k ri - by Rtis Lau 2. ail ndi<ione that iirdetxte a 'blc release are roves' mrd 3. all mo � records arc maiata�d THE FOLLOWING PERSONS)ARE RESPONSIBLE FOR PERFORMAND EQUII`MEN I N•AIIJCEMANCE PERFORMING THE MONITORING 490-73- 490-72. NAME 190.14. lT �- - a. 3 Q 0.A a n -- 490 7s ll,g: NAME _ _ The 17csigtated UST Operator shall perform a►noatitiy visAll ael inspection of the facility,provide provide n m the owns!R ,and inform the ownerloperator of any conditions that need follow- action. {meq IFICA I ION:I PRrtify at the o it herein is free and accurate to the bat of my knowledge. 49047. DATE APPLICANT SIGNATURE / / /l t3L•PAESENrINQ 7.7ank Ownrs (]2 3.Amtwaccd l2f - nfOwner178b. V v --7� f L/ 490-79. APPLICANT TITLE: APPLICANT NAME(Print)- Jh U t/� f L .rvrw.uutdocs.org UPCF UST-D(IMWI)-3/4