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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING:. 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54a D 1. CONTINUOUS ELECTRONIC MONITORING X2. FLOAT AND CHAIN ASSEMBLY 113. ELECTRONIC STAND-ALONE 490.546 04. NO DISPENSERS 99. OTHER (Specify): _❑ _ — PANEL MANUFACTURER: — ----_�—�� -- — – – — — 490-55 r–MODEL #: — -- – — _ 490,56. -- 49057 MODEL #(S): — – —�� LEAK SENSOR MANUFACTURER:— 490.58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a YES ❑ b. NO 4W34— 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 490.61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. a. YES ❑ b. NO 490-62 2. UDC CONSTRUCTION IS SINGLE -WALLED ❑ 2. DOUBLE -WALLED 490.63 IF DOUBLE WALLED: a90 -64a UDC INTERSTITIAL SPACE IS MONITORED BY: 1. LIQUID [12. P_R_ESS_URE [13. VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a. YES [3b. NO 490-"6 77, 777 Vll. PERIODIC SiSTEM TESTING , 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. LEAK DETECTION (ELD) MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVER_ Y36M_O_NTHS AS REQU RED. (23 CCR §2644.1) _ – — ® 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 3. SPILL BUCKETS ARE TESTED ANNUALLY. — — -- — 490.67 ". VIII: RECQRDKEEPING Y4^; The following monitoring/maintenance records are kept for this facility: ® Alarm logs 490fi8a ® Visual Inspection Records 490-696 ❑ Tank integrity testing results 490-68c Q SIR testing results (and supporting documentation records). 490.69d ❑ Tank gauging results (and supporting documentation records). 490.68e ❑ ATG Testing results (and supporting documentation records). 490-"f ❑ Corrosion Protection 60 -day logs 490-681; ❑ Equipment maintenance and calibration records. 490.68h IX: TRA##$O + ® Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490.69a REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 49o -69b ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 490.69c ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION 490.69f ❑ SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490-69$ ❑ OTHER (Specify): M69h, 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 D Names of contact person(s) for emergencies and monitoring alarms. 490.70 X.. +COMMENTS/ADDITIONAL-iNFORMATIOI�F, .._ .,, Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan. 49o-71 Tank Overfill Prevention: Mechanical flappers set at 95% 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 possible release are investigated, and 3) all monitoring records are maintained properly. The following person(s) are responsible for performing the monitoring and equipment maintenance: NAME Store Manager 490,72 TITLE Store Manager 490.73 NAME Kent Cain 490-74 TITLE District Manager 490-75 The Designated 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. 0 "KWOPERATOR SIGNATURE CERTIFICATION: I certify that the information pr yided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE 490.76 DATE: 490-77 5/8/08 1 Tank 1er/O r:ratnr O 2. F lit Owner r for 3. Aythqijzgd WrenniativI o[Oweer APPLICANT NAME (print): 490'79 APPLICANT TITLE: 490-79 Stephen Boyd HSE Specialist UPCF UST -D (12/2007) 3/4