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ti UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN— (Page 2 of 3) VI. UNDER DISPENSER CONTAINMENT (UDC) MO`ITORING (Check all thatapply) UDC MON71TORFNG IS PERFORMED USINU THE FOLL.OWI\0 METHOD(S) ® 1 CONIINUOUS ELECTRONIC MONIIORING ❑ 2 FL.OAI AND CHAIN ASSFMBL Y ❑ 3 ELEC I RONIC S I ANF-AL ONF 490-54a 490-soh ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify_) —._.. .......... -- - LEAK MONITOR MANUFACTURER:Veeder Root 490-5s MODEL#:TLS-350 490-s6 LEAK SENSOR MANUFACTURER:Veeder Root 490-57 MODEL.#(s):794380-323 49D-58 DEIECIION OF A LEAK INIO I HE UDC TRIGGERS AUDIBI E AND VISUAL ALARMS M a YES ❑ b NO 490-59 UDC LEAK At ARM IRIGGERS AUTOMATIC PUMP SHUIDOWN ® a YES ❑ b NO 490.60 FAIL URE/DISCONNECIION OF UDC MONITORING SYSIFM IRIGGERS AUIOMAIIC PUMP SHUIDOWN ® a.YES ❑ b NO 490.61 UDC MONITORING STOPS THE FLOW OF PRODUCT AI I HE DISPENSER. ® a-YES ❑ b.NO 49°-62 UDC CONSTRUCTION IS: ® I SINGLE WALL ❑ 2 DOUBLE WALL 49°63 490-64a 1F DOUBLE WALL: UDC INTERSTITIAL SPACE IS MONIIORED BY: ❑ a LIQUID ❑ b PRESSURE ❑ c VACUUM A I-EAK WITHIN IHE SECONDARY CONTAINMENT OF THE UDC TRIOGF.RS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO 490.64b VII. PERIODIC SYSTEM TESTING ❑ 1 ELD TESTING THIS FACILITY HAS BEEN NOTIFIED BY THE Yl A"I'E WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65 LEAK DETECTION ' DMUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONT HS AS REQUIRED. z,CCR§2644 2. 490-ss ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-67 ® 3.SPILL BUCKETS ARE TESTED.ANNUALLY. VIII. RECORD KEEPING '` _ The following ntonitoring/maintenance records are kept for this facility: 49e-60- ® a ALARM LOGS ❑ b VISUAL-INSPECTION RECORDS ❑ c IANK INTEGRIIY IESTING RESUL IS ❑ 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 PROTECT ION 60-DAY LOGS ® h.EQUIPME-NI MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING ® Personnel with UST monitoring responsibilities are familiar with ail of the following documents relevant to their job duties: 0 690- REFERENCE DOCUMENTS MAINTAINED ATFACILITY(Check all t{wt apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490-69b ® OPERATING MANUALS FOR ELEC I ROMC MONITORING EQUIPMENT(Required)* 490-69e ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d ❑ CALIFORNIA UNDERGROUNDS TORAGE IANK LAW 490-69` ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: 'HANDBOOK FOR TANK OWNERS - MANUAL AND 490-69f SIAIISIICAL INVENTORY RECONCILIATION" 490-698 ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMAIIC TANK GAUGING SYSTEMS" 490-69h ❑ OTHER(Specify): 490.691. ® 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 US I 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 rote with regard to spills and overfills as specified in the facility's US I Response Plan ➢ Name(s)of contact person(s)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan 4900-1 *Monitoring systems manual maintained by contracted,licensed pump and tank technicians.. Best Management Practices are maintained in the H S.S.E.Retail Facility Programs Manual(Green Binder) *T'ank Overfill Protection Type: Overfill alarm and hall float,visual and audible alarm at tank fill Dints and o crates ahu ms trigger at 90%. XI. PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that. I)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered by thisplan occutsi-2.�all conditions that indicate a possible release are investigated_and 3:)all monitoring records are maintained propel_ ........,-............ THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: STEVE COiViLEY 490-72 7IILE: IiSSE MANAGER 490-73 The Designated UST Operator 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 f011OW-Up action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE — DATE: 490-77 REPRESENTING:I]I.Tank 0—cr/0 grata f or tM 3 Authorized Rcpre tative of Owner 490-76. APPI ICANT NAME(print): 490-79 APPL ICANT T1T1 E: 490-79 RICHARD GOSSETT Environmental Compliance Specialist Arco 06080,Belshlre Environmental Services Page 2 of 6