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} UNIFIED PROGRAM CONSOLIDATED FORM WIN UNDERGROUND STORAGE TANK NIT —(Page 2of2 ORION In UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) " ❑ L CONTINUOUS ELECTRONIC MONITORING ® 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 49 sea ❑ 4.NO DISPENSERS ❑ 49 OTHER(Specify) 490-54b. LEAK MONITOR MANUFACTURER: a s MODEL#: 96:5(C LEAK SENSOR MANUFACTURER: 490-57 MODEL#(S): 490-58, DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a YES b.NO 490-19. UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN, ❑ a.YES b.NO FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES IN b.NO 490.61. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. 490-62 _.,. _ _ a.YES ❑ b NO UDC CONSTRUCTION IS: ._...___- I.SINGLE WALL --4"-6_____...._. 2.DOUBLE WALL a�-si. IF UBLE WAI : ago-ea. UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a LIQUID ❑ b.PRESSURE ❑ c.VACUUM A LEAK WITHIN THE SECONDARY CONT,A,INM,ENT,OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO 490-64b. I.ELD TESTING. IS FACILITY HAS BEEN NOTIFIED BY STATE WATER RESOURCES CONTROL BOA THAT ENHANCFn 490'-65. MUST BE PERFORMED. PERIODIC ELI)IS PERFORMED EVERY 36 MONTHS AS REQUIRED. as Cca ta6aa.t 2.SECONDARY CONTAINM T COMI�INENTS ARE TESTED EVERY 36 MONTHS. a 3.SPILL BUC ARE TESTED A UALLY. 49047 .. ' The followi �r''i n, g/mainteriance records am kept for this thcntty: a '`a 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 DAY LOGS h.E )UIPMENT MAINTENANCE AND CALIBRATION RECORDS Personnel with UST monitoring ibitities f iliac with all of the fallowing" uments relevant m ttreir job REFERENCEduties: .4 v DOCUMENTS [NTAINED AT FACILITY(Check ati Iliac DIY) THIS UNDERGROUND STORAGE TANK MONITORING FLAN(Rsqui } OPERATING MANUALS FOR ELE ONIC MONITORING EQUIPMENT(Required} [3CALIFORNIA UNDERGROUND STORAGE TANK GULATIONS 490-0c. [3CALIFORNIA UNDERGROUND STORAGE TANK LAW a STATE WATER RESOURCES CONTROL A a (S CB) PUBLICATION: "HANDBOOK FOR 'TANK OWNERS - MANUAL AND a STATISTICAL INVENTORYRECONCILIATION" ❑SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490-698. ❑ OTHER(Specify): 490-6%. 11119 This facility has a"Designated UST Operator"who California UST Sy m rator E administered: the 1111tonal Code Council a azo. (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 l ire.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. D 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 al vide additional commentsre or itxli to how pages with iii info ton ons iftc mani Ing procedures a to this plan. Gu ntly the alta Itaa over till ntlon of rrtechanit�l flap aet et 9596 of tank cepaclty. 490.71. The UST r! calor is responsible for utittg that: L}the daily! tine UST mall ietg putties maintenance"of UST leak detection equipment covered b tftis oceursR 2.�plt cotutition that Indic assible-I---are investi and 3j all monitorm records are maintained to rl . THE FOLLOWING PERSONS)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE NAME: Affen Fam 490.72. TITLE: NAME: an 490-73. 490'-74 TITLE: 49e.75. i ed UST r shaft1 riforim a monthly visual inspection of the facility,provide a report to the o rloperator,and inform the owner/operator of any conditions that follow-u action. `- OR SIGNATURE , #AIPIeLn'CFaass ON;[cern that the Into atioa rovlded herein is true and accurate to the best of m knowledge. ADATE: j�l Tm er er a9¢-76, 1`11- E(print}: 496-78. APPLICANTTITLE: 490.79. Complian ce UPCFUST-A(IV2 )-3!4 w.unidecs.org