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UNDERGROUND STORAGE TANK MONITORING PLAN-PAGE 2 V1.DISPENSER MONITORING MONITORING OF AREAS BENEATH DISPENSER(S)IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) M50. ❑ 1.CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT(UDC) M52. PANEL MANUFACTURER: M"- MODEL#: LEAK SENSOR MANUFACTURER: M" MODEL#(S): M54. WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? n a.YES El b.NO M" WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? El a.YES El b,NO M16. WILL FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? El a.YES [I b.NO M17. 2.MECHANICAL ASSEMBLY(e.g.,FLOAT AND CHAIN ASSrBLY) S SHEAR VALVE IN CASE OF LEAK ASSEMBLY MANUFACTURER: zt W� ,t) _1k1h 1 5 C_*� D 1 _ -I-- MODEL#(S): M59, P 3.VISUAL MONITORING DONE: fo a.DAILY F1 b.WEEKLY(Requires agency approval) M60. D 4.NO DISPENSERS El 99.OTHER(Specify) M6L VH. ENHANCED LEAK DETECTION El 1.WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK M")' DETECTION(ELD)FOR THE UST(S)COVERED BY THIS PLAN.PER 23 CCR§2644.1,ELD IS PERFORMED EVERY 36 Mgj!4THS AS REQUIRED V111. T REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) M80, 1. W THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 2. OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 3. THE FACILITY'S BEST MANAGEMENT PRACTICES(Required as of 1/01/2005) 4. CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. CALIFORNIA UNDERGROUND STORAGE TANK LAW 6. M STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 7. rl SWRCB PUBLICATION:"WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" 99. M OTHER(Specify): Mai. Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those 6ocuments when needed. By January 1,2005 this facility will have a"Designated UST Operator"who has passed the operator exam administered by the International Code Council(ICC). By January 1,2005,and annually thereafter,the "Designated UST Operator"will train facility employees in the proper operation and maintemince of the UST systems. 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 leak detection equipment. > The facility employee's role with regard to spills and overfills. > Whom to contact for emergencies and leak detection alarms. For facility employees hired on or after January 1,2005,the initial training will be conducted within 30 days of the date of hire. IX COMMENTS/ADDITIONAL INFORMATION Please use this section to'include additional UST system monitoring-related information(e.g,,additional information required by your locall agency): M85. ly ;II A- ,,,Jian �Wvi X. PERSONNEL RESPONSIBILITIES AS OF 111105, THE"DESIGNATED UST OPERATOR!'IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PEPAUT APPLICATION— FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIPMENT COVERED BY THIS PLAN,AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S UST SYSTEMS IN ACCORDANCE WITH 23 CCR§2715(b). I. OWNER/OPERATOR SIGNATURE CERUFICATION-I certify that the information provided herein is true and accurate to the best of my knowledge. OWN PERATOR SIG A REPRESENTING DATE: M9L Owner m9o. Operator OWNS 0M RERATOR NAME(print): OWNER/OPERATOR TITLE: M93, A.) (Agency Use Only) This plan has been reviewed and: Approved C1 Approved with Conditions ❑Disapproved Local Agency Signature: Date: �171e� - Comments/Special Conditions: SJCEHD-d(07/03)-314 07123/03