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J - UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI iJ1NDF,R DISPENSgpl:CONTAINMEN P(UDC MONI`I BRING I. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54 [R'1.CONTINUOUS ELECTRONIC MONITORING El2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490.546 ❑.4.NODISPENSERS 099.OTHER(Specify)` PANEL MANUFACTURER90" ago ss .:MODEL#: "Tree,• 3 S":D 490-56. LEAK SENSOR MANUFACTURER: 490-57 MODEL#(S): 9 rj- O 490.58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS P*YES ❑b.NO 490.59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN Ott a YES ❑b.NO 490-so. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM'TRIGGERS AUTOMATIC PUMP SHUTDOWN. q-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 31.SINGLE-WALLED ❑2.DOUBLE-WALLED 490.63 IF DOUBLE WALLED: 49"U UDC INTERSTITIAL SPACE IS MONITORED BY: 1.LIQUID El 2.PRESSURE 3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a YES ❑b.NO 490-64b ,VLL:PEItIODTC SYSTEM�STA�TG :.' ❑ 1.ELD TESTING.THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490.0. LEAK DEN LD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED (23 CCR¢26441) .SECONDARY CONTAINMENT COMPONENTS ARE TESTED EWRY36 MONTHS. 490.66 SPILL BUCKETS ARE TESTED ANNUALLY. 49067 • ' ,.VIII:R�CQRDKEE$ING ;:. The following monitoring/maintenance records arc kept for this facility: Alarm logs 490.69a [3spal Vilnspection Records 490-6ab ❑Tank integrity testing results 49o4oc ❑SIR testing results(and supporting documentation records). 490-6ad ❑ Tank gauging results(and supporting documentation records). 490.686 ❑ATG Testing results(and supporting documentation records).49&68f ❑Corrosion Protection 60-flay logs 4"S quipment maintenance and calibrationrecords.49"gh TX.TRAINING. IAPersonnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 49049a REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ❑ THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490.69b ❑ OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required).49os9e ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69. ❑ STATE WATER RESOURCES.CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"49"9f ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-69g ❑ OTHER(Specify):,M69k 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 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 UST Response Plan Names:of contact person(s)for emergencies and monitoring alarms.490.7o X. CQMMENTS%AADZTIONAL1NFORM1TIQN Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan. XI.PERSONNEL RESPONSEWLITIES- The UST Owner/Operator is responsible for ensuring that:1),the daily/routine UST monitoring activities and maintenance of UST leak detection equip!!i by this plan occurs,2)all conditions that indicate a possible release ate investigated,and 3)all'monitoring records are maintained properly. The following person(s)are responsible for performing the monitoring and equipment maintenance: NAME. 490-72 TITLE NAME 70- 490-74 TITLE 0.75 The Designated Operator shall perform a monthly visual inspection of the facility,provide a report to the owner/operator,and infoim the owner/operator of any conditions that need follow-up action. 'XII.OWN MOPERATOR:SIGNATURE CERTIFICATION:I certify that,the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE 490-76 DATE: 490-77I i O r r u' APPLICANT NAME(print): 490-78 APPLICANT TIME: 490.79 UPCF UST-D(1212097)3/4