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L!LIFTED PROGR41f CONSOLIDATED FORM <br /> UNDERGROUND STOPLAGE TANK <br /> 4fOa iITOR1iiG PI..kN (Page 2 of z) <br /> —•---- 6'7i.Uu17ET�.T)TSP!EsFSE'R:G}(?I�2�1`t�L'�i411E (UDC�1Kb�FZFQTciLItiG .. ..' <br /> I`IJDCMONITORING ISPERFOILMEDUSING THE FOLLOWING METHOD <br /> I.CONTINUOUS ELECTRONIC MONIIORING �(2 FLOAT AND CHAIN ASSEMBLY 0 3 LFCTRON1C STAND ALONE <br /> L3 4 NO DISPENNSERS ©49.OTHER Specify): <br /> PANELMANUFACTURER: ® 4fODcLts <br /> LEAK SENSOR MANUFACTURER: _ l MODEL-#(S): <br /> DETECTION OF A LEAK rNTO THE UDC TRIGGERS AUDIBLE AND VISUAL.ALARMS i 3 YES 1-!b NO <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP ShUIDOWN j a YES fXb NO 49aso <br /> FAI1UPE/DISCONNECTION OFUDCMONIIORlNG SYSTEM TRIGGERS AUTOMATIC ptiMp SHUTDOWN aYES [Zb.NO <br /> f UDC MONITORING STOPS THE FLAW OF PRODUCT AT THE DISPENSER. x a.YES ®b.NO t�ssa <br /> �2.UDC CONSTRUCTION IS 1.SR4OLE-WALLED G)2.DOUBLE-WALLED Y—�— —_ 4 <br /> IF DOUBLE WALLED-. � ase yrs <br /> UDC INTERSIITIAL SPACE IS MONTIORED 3Y: L LI UID E12,?RESSUR4 03.VACUUM <br /> --A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS L]a.YES 0 b,NO <br /> 1 ELD G-.THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT Ely,,-=IANCEI) <br /> MUST BE PERFORMED. ERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS 0_UT1ia-(23 CCR$2644.1L� <br /> 2.SECOI D.1R"Y COTrITrALwENr COMPONEI IS ARE TESTED EVERY 36 MONTUS <br /> �._____..—...,.._�_.—�.«..._.._...._....«.....-....—..,....._.._.._........._.........__...._.__....__...,.._....._.__..,._._«_....._-_...._.♦965 �. <br /> 3 SPILL BUCKETS ARE TESTED ANNUALLY, 4MaY <br /> TTso fBllowitsg tewitorn4ghnain reeimds ars kept for this <br /> Alarm top s 1 Visual Inspection -fart&untpay(Cutin$resuks OwAft <br /> SIR testing resnhs(and suppartingdocumenturtion r ) mows ® Tank gauging results(and supporting documentation records) 49"ft <br /> Q AT'G T-fm sults{and ting mtadoa tends) Mg of C] Cone Ptatectim 6P dap bgs 4W449 <br /> ram!calibration mootds 4%m <br /> Forsommej with tsirmicaftoring responsibilities are tinnifum with an of the following documents relevant to their job duties <br /> CE DOCUMEIM MANTADMID AT FACILITY(Cbwk all that apply) <br /> THIS UNDERGROUND STORAGE TANK MONTIOMG PLAN(Refui.ed)4Will- <br /> TING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Requirod)i4904ft <br /> 29 CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4WM <br /> CALIFORNIA UNDERGROUND STORAGE TANK LAW <br /> ® STATE WATER RESOURCES CONTROL BOARD(SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS-MANUAL AND <br /> STATISTICAL INVENTORY XECONCILIATION" <br /> CS SWRCB KMUCAIION:"UNDERSTANDING AUTOMATIC TANK GAUGIT4G SYSTIk° S'O"ga <br /> NJ®OILIER(SpGeify):er�h <br /> This facility has a"Designated LIST Operator"who has passed the California USTSystG'Operzioz Exam admudstcaed by 0c kdaux+tio*4 Code Council(ICC) <br /> The"Deaignatod USI'Operator"will twain facility employees in the proper operatioa and mainte.naane of the UST systems annually,and within 30 days of hire This <br /> training will include,but is not limited to,the following: <br /> D Operation of the UST system ins manuer consistent with die facility's best mcgascine st practices <br /> D The boility c.nployea°s role with regard to the monitoring equipment as specified In this UST Mcnitoting Plan <br /> 9 The tisility employee's tole with regard to spills and over filla as specified in the UST Response Flim <br /> P Kan=of otiataet pe sons)let emergencies and asonitoring alaf= 494-N <br /> t.. .P <br /> ti <br /> 3 `S n. ;.x`G'°.L�'t tfi.t .• _ s , �.-. ... qty'. <br /> Provide additional comments here or indicate haw many pa as ws Kid—ona1 information tae specific munitor[ag pfocedrues are attached to this plan agar. <br /> _ r - <br /> a r <br /> .k <br /> , a <br /> -Fa . 3atl <br /> The UST Owner/Operator is responsible for rew—uri that:`)the dailyhostine UST monitoring activities and maintenance of UST leak detection equipment covered by <br /> this pian occurs,2)all conditions that indicaw,a possible release arc investigated,and 3)all monitoring reeoids are maintained properly <br /> The toRowin s s wejasible for perfuming the monitot ing and cquipmwt maintensnee: <br /> NAME `f + aco-rt TITLE -- --- +9043 <br /> NAME 490-74 TITLE 490ts <br /> The Designated Operator shall perform a monthi, visual inspection of the facility,provi&a report to the ownetfopera'or,and inform the owner/operator of may <br /> conditions that need follow-up action <br /> s — '00NERI01rVkA-T(J1ZSIGGAF6R� <br /> CERTWICATIO\ % ' that .infqXnatiqqAffovjP- rein is tn:e and accurate tp the best of my knowledge. <br /> APPLICANT SIGN r' ✓j' ! 440.75 DATE: 490M <br /> 490-7449779 <br /> APPL[ ANTNA (print): APPLICANT:ITL t�C G <br /> fir✓ `I � a J <br />