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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT(UDC) MONITORING (Check all that apply) UDC NITORING IS PERFORMED USING THE FOLLOWING METHOD(S) I.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54& ❑ 4.NO DISPENSERS ❑ OIHERS ify) 490-54b. LEAK MONITOR MANUFACTURER: aso ss. MODEL#:I -S-t5 49056. LEAK SENSOR MANUFACTURER: C 490.57. MODEL#(S): o.� 48. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ESS ❑ b.NO 490-59. UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. [AYES ❑ b.NO 4W-60 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. 0-n YES ❑ b.NO 490-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. I---- . ES ❑ b.NO 49M2 UDC CONSTRUCTION IS: ❑ 1.SINGLE WALL CT 2.DOUBLE WALL 490-63. IF DOUBLE WALL: 490-64& UDC INTERSTITIAL SPACE IS MONITORED BY: LIQUID ❑ b.PRESSURE ❑ c.V M A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. .YES ❑ b.NO 490-64b- VII. PERIODIC SYSTEM TESTING STING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. K DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.123CCR§2644.11 WILLSFCONDA CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490 66. ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-67. VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 490-68, ® a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) ❑ f.ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS ® h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING ® Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: 490-69a REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 49"9b ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490-69c. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490.69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 49059f.. STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 49069g. ❑ OTHER(Specify): 4905911 axo-6x1. ® This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 490-70. (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 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 Monitoring Plan. ➢ The facility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. ➢ Name(s)of contact person(s)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide additio I o ete or indicate how man SAW adc(iiiQnal n ons ific monitoripg.proce r ed to hip 490-71. C t `�° "flo fu =s F-,�W Ar )''Uva 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 pmible release are investigated_and 3.)all monitoring records are maintained properly_ _ THE FOLLO G PERSON(S) RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE NAME: C��l/YYr�6VL 490-72. TITLE: 49D-73. NAME: 490.74. TITLE: 490-75. The Designated UST Operato 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 certi that h infor 'on provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 490-77- � l�t � y REPRESENTING:❑I.Tank Ownerloperator❑2.Facility Owner/Operator❑3.Authorized Reprmentalive of Omer 490-76. APPLICANT NAME(print): 490-78 APPLICANT TITLE: 490-79. x- UPCF UST-D(12/2007)-3/4 www.unidocs.org