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-Ammik <br /> W 0 , <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN (Plage 2 of 7) <br /> VL UNDER DISPENSER CON TAWMENT(IJDO MONITORING <br /> I. UDC MON111110 IS PER01ORMED USING THE FOLLA)WING MrMOD a9a as <br /> 0 1 CONTINUOUS 91,uCTRONIC MOMTORING 1--]2.FLOAT AND CHAIN ASSEMBLY [1 3.ELECTRONIC STAND-ALONE <br /> F (specify): <br /> _,1_j..NOOI$PENSERS 4W46. <br /> �AWFZ;�A—NUFACTtliii— .3 fi: <br /> -n,,,,, 3Z; 2-- - ­-- 49o-st <br /> LEAK SENSOR MANUFACTURER- MODEL <br /> D M. ZHON OF A LEAK WM THE UDC TRIGGERS AUDIBLE AND VISUAL-1AkMS a.YES [I b.NO 490" <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SUUTDOWN [?&.YES 0 b.NO 490, <br /> FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. YES b.NO 490-61 <br /> UDC mONITOTUNG STOPS THE FLOW OF PRODUCT AT THE IXSPCNS6R. YES Q b.NO 490,62 <br /> 1 UDC-CONSTRUCTION IS [31.SINOLE.WALLr-n 2&2 DOUBLFWALLED -70-51 <br /> IF DOUBLE WALLED- <br /> UDC INTERSTITIAL spAg is mctNrMkgD yj i Ll �Ulf) 2.�PRESSU�RE 0 3.VACUUM <br /> L_L _� To -b <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAI,ALARM$ Cla,YFZ Elb <br /> VII.PERIODIC SYSTEM TESTING <br /> Ll 1.9LD TESTING:THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WAITiR RESOURCES CONTROL BOARD THAT RLHANCEP 49w- <br /> LF4K 2EMO <br /> QN(131,D)MUST BEPBUORMbo. PERIOTIC ELL IS PERFORMED EVERY 36 MONT14S ASU-.OkLrRL-P. 3 C;CPt7,6".❑ l) <br /> 49046 <br /> 2.SXCONOARY CONTAINMENT COMPONENTS ARE TWrlrO I&VERY 36 MONrk(S. <br /> C3 3.SPILL BUCKM An TESTI&D ANNUALLY. 490.67 <br /> VITT.WORDKEEPING <br /> foilOwing molliwio8/maintaninccrecords are kept fon this ftoility; <br /> Alarm logs ago ja-Vistiiij Inspection PtWdS 4:M 'ink integrity W$jinp results 4904k <br /> EISIRiesda results(and supporting documertwien records). `p Tank pAveirtp results.(and supporting documentation MzOrdS). 440-&k <br /> [3 ATG Testing results(and supporting documentation nxofds) 490 ser 0 Corrosion Protection 60-day JOBS 49"8j; <br /> P�uipmcnt maintenance and calibration records. 49MA 19-;, Lcn—s <br /> IX.TRAINING <br /> ❑p..I%ith Un—.*njZWjnp ocuments relevant,r�po.ibfijtics.,e%.ilia,with all of the following d t to theitjob dudes. 490-am <br /> REPER-ENCE DOCUMENTS MAINTAWED AT FACI11TY(Chetr411 dW apply) <br /> Q THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)49NOb <br /> [3 OpEPATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT'(ReVilred)490669,; <br /> [3 CALIFORNIA UNDERGROUND STORAGE TANK RldGULATTOM M.&d <br /> CALIFORNIA UNDERGROUND STORAGE TANK LAW 4so-we <br /> STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS MANUAL AND <br /> STAIISTI(CAl.INVENTORY RECONCILIATION"49ii-W <br /> Ij SWRCB PUBLICATION''UNDERSTANDtINIG AUTOMATIC TANK GAUGING SYSTEMS"490-0v, <br /> 13 OTHER(SpeCiFy):m69hm" <br /> Ll This f2cility,has a'Designated UST the California UST System Operator Exam administered by the international Code Council(ICC) <br /> Tbe"Designated LIST Operator"will train facility employees in the proper operation and maintenance of the LIST systorris annurily.and within 30 days of hire.Thdi <br /> training will include,but Isnot limited to,the,following: <br /> > Operation of tie UST Systerris an manner consistent with the facility's best nurialIgment Practices <br /> P Tbc facility employees role with ward to the in this USTMOnitoring Plan <br /> > The facility employee's role with regard to spills and ovorfdls as specified in the UST Respiom3c Plan <br /> )> Names of contact person(s)for emergencies and monitoring alarms.4VO-70 <br /> X COMMENTS/ADDITIONAL INFORMATION <br /> Provide additional comments here or indicate how many pages with additional inforn-066P On Specific Monitoring procedures are attached to this plan.400-71 <br /> XI.PERSONNEL RESPONSIBILITIES <br /> The UST —bp4010 for ensuring tbtft.1) daily/routine UST monitoring activities 4nd maintenance of UST leak detection equipment co by <br /> F"w -= 115i <br /> this plan 2)all MAti th%indicate a possible rallease are Investigated,and 3)all monitoring records are maintained properly. <br /> The fol , on(s)a r po c for performing the mtinilOfiftf,and eqWPn=mftin&MS 4W?3 <br /> lo� 4w-n 1 <br /> NAME TrCLE <br /> NAME 4 490-74 TITLE. 490M <br /> The Cicsipatod Operator shall Wform a monthly visual istspection of the facility,provide a report to the owner/operator,and inform the owner/operator or any <br /> conditions that need follow-up action. <br /> X11.OWNER/OPERATOR SIGNATURE <br /> CERTMCATiUN.t certify that the info;�ayon provided herein is true and accurate to the best of my knowledge. <br /> APPLICANT SIGNATURE 490.76 DATE: 4-,40677 <br /> APPLICANT NAME(gr4W7;in* APPLICANT TITLE, 4W79 <br /> UPCIP UST-1)(12r20(17)3/4 <br /> GOO/ soold OS90# 9t:10 9002/tT/TT <br />