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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - Pale 2 of 2) (Chll VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING l that that a 1 y) apply) UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 1. CONTINUOUS ELECTRONIC MONITORING ❑ 2. FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONE 490-54& ❑ 4. NO DISPENSERS ❑ 99. OTHER (Specify) 490-54b. LEAK MONITOR MANUFACTURER: ae-4 d R ✓ a90 -ss. MODEL #: Ti.- 9 13:E6 490-s6. LEAK SENSOR MANUFACTURER: %re.0-JiL114psaT, 490-57. MODEL #(S): '3 'Z- 490-58. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. A a. YES ❑ b. NO 490-59. UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. X a. YES ❑ b. NO 49M0 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. If a. YES ❑ b. NO 490-61. UDCMONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. a. YES ❑ b. NO 490.62. UDC CONSTRUCTION IS: 1. SINGLE WALL ❑ 2. DOUBLE WALL 490 -61 IF DOUBLE WALL: 490-64& UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a. LIQUID ❑ b. PRESSURE ❑ c. VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a. YES ❑ b. NO 490-64b. VII. PERIODIC SYSTEM TESTING ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. LEAK DETECTIONELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 123 CCR §2644.11 ® 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66. ® 3. SPILL BUCKETS ARE TESTED ANNUALLY. 490-67. VIII. RECORD KEEPING 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 ® h. EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING ® Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: 490-69& REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 490-69b. ® 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 490-69f STATISTICAL INVENTORY RECONCILIATION" ElSWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490 69g. OTHER(Specify): 490. [I OTHER ® This facility has a "Designated UST Operator" who has passed the California UST System Operator Exam administered by the International Code Council 0-90 70. (ICC). The "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST system �Yt� days of hire. This training will include, but is not limited to, the following: ' 1 [ ➢ 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 facility's UST Response Plan. 2 � .� �1, `_ y F, q ➢ 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 attacppdt�jlaq 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 are_maintained properly. __ _.. THE FOLLOWING PERSON(S) ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: 490-72. TITLE: 490-73. 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. X1J. OWNER/OPERATOR SIGNATURE CERTIFICATION: I certify that the i forma 'on provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 490-77. XQ�f 1 REPRESENTING: [11. Tank Omer/Operator ❑ 2. Fwili /O rator ❑ 3. Authorized Repmmtafive of Owner 490-76. r APPLICANT NAME (print): 490-78' �O APPLICANT TITLE: 490-79. UPCF UST -D (12/2007) - 3/4 www.unidocs.org