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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN — (Page 2 of 2) �. VI' UNDER DISPENSER CONTAINMENT (UDC)1VIONITORING (Chickjall ...;. - ,. that app,! UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) C9 1 CONIINUOUS ELECTRONIC MONITORING ❑ 2 FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONE 490-54a ❑ 4. NO DISPENSERS ❑ 99. OTHER (Specify) 490.54b LEAK MONITOR MANUFACTURER: 4� 490-55 MODEL #: 490-56 LEAK SENSOR MANUFACTURER: 490-57 MODEL #(S): �210 19 490-59 DEIECTION OF A LEAK INIO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS O[ a. YES ❑ b. NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ® a YES ❑ b NO 490.60 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN ® a. YES ❑ b NO 4901 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER a. YES C1b_No 4�2 —_— UDC CONSTRUCTION IS: I SINGLE WALL ❑ 2 DOUBLE WALL 4905 IF DOUBLE WALL: 490-64a UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a LIQUID ❑ b PRESSURE ❑ c VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UD�Cr TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a. YES ❑ b. NO 490-64b x ,.� �.6 �, ri, d ' T .! r„ ta`i`KrT,�� ,s,4..ai. ...� �, 'i•,^,'�,L,,'F4':�� a`�,a 7. a .. ��x�, .r�'.� IELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCEP- 490-65 LEAK DETECTIQNLELDI MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 ccR 32644.1 ® 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 ® 3. SPILL BUCKETS ARE TESTED ANNUALLY. 490.67. 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 ® hn�.. UIPMENI MAINTENANCE AND CALIBRATION RECORDS ,E ��ci,1 "et�aki' gym, f''.'^ ?kYh f tof.}a.-�L.: R hens+, Y 4Kx— . r.. - ,'s M'-mY .4.: 1 NW v 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) 49M9b ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 490-69c CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69& CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e ® STAIE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 490.69f STAIISTICAL INVENTORY RECONCILIATION" ( SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490-698 ❑ OTHER (Specify): 490-69h 490.69i. 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 Ihis 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 USTMonitoring 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 alarms20, HIM wy', .. Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan 490-71 The UST Owner/Operator is responsible for ensuring that: I ) the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered -bythisclsn occurs= 2.) all conditions that indicate aDoossible release are investigated; and 3.) all monitoring records are maintained p-roperlY. THE FOLLOWING PERSON(S) ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: T� (�^ 490-72 TITLE: ,QS yt 490-73 NAME: T y� — 1 � NAME: 490-74 TITLE: 490.75 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 follow-up action. XII:.;OWNERI ERA'FOR SIGNAI'UR - CERTIFICATION: I cern a e iptormatVprovideC ein is tree and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 490.77 REPRESENTING. [11. Tank O era er eraror�.op...ivedOwner 490-76. APPLICANN, �N�AME (print): 490.78 APPLICANT TITLE^-- 490.79.14M9 d' Mck UPCF UST -D (12/2007) - 314 www.unidocs.org