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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROITND STORAGE TANK MONnORING PLAN- Page 2 of 2 UDC MON!'IORiNG IS PERFORMED USING THE FOLLOWING MEI'T•IOD(S) . ® L CONTINUOUS ELECTRONIC MONTTORING .FLOAT AND CIIATN ASSEMBI.Y ❑ 3.ELECTRONIC STAND-ALONE 4'0's4a ❑ 4.NO DFSPIIVSERS _ ❑ 99-OTHER(Specify) 49045w. LEAK MONITOR MANUFACTURER: 455. MODEL#: 4 . LEAK SENSOR MANUFACTURER: _ 49Q" MODEL#(S): 490-58. DETECTION OF A LEAK INTO I'HE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO 490-59- UDC LEAK ALARA+!TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 49w- FAILI)RElD1SCONNECTlON OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ :L YES ❑ b.NO 490°!• UDC MONITORING STOPS THE FLOW 01;PRODUCT AT THE DISPENSER_ ❑ s.YES C3 b.NO 49M,62, _._. _ UDC C ONSTRUCTION 1S: ❑ 1.SINGLE WAIL ❑ 2.DOUBLE WALL a9asa. 1EPQ1ML1 WALL: UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a.LIQUID ❑ b.PRFSSURE ❑ c.VACUUM 490.64a• A LEAK WITILIN THE SECONDARY CONTAINMENT OF TIIE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES Elb.NO 4b- 1.ELD TESTIriG: THIS FACILITY HAS BEEN NOTIFIED BY THE..STATE WATER.RESOURCES CONIROL BOARD Tt1A'I'l�I_icI lNCED 49"5. LEAK ECTI N(ELDI MUST BE PFR.FORMIED. PERIODIC BLD IS PERFORMED EVr.py 36 MONTHS AS REQUIRED.I23 ctlt4264a.1I ® 2.SWONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49046. ® 3.SPILL B(ICKETS ARE TESTED ANNUALLY. 44M7 The foElo .. wing rnonkoring/maintenanec records arc kept for this facility: ® a.ALARM LOGS ❑ b.VISUAI,INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS ❑ d.SIR TESTING RESULTS(and suppOrtiq documenWiOn records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) EJ f ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS ® h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS .::....... Personnel wiilt UST monitoring respprasl r clues arc familiar with all of the:following documents relevant to their job duties: 45 REFERENCE DOCUMENTS MAINTAINED AT FACILITY KWack all rhes apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Requited) 4 OPERATING MANUALS FOR ELECTRONIC MONITORING P..QUIPMENT(Required) 4 ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4y 13 CALIFORNIA UNDERGROUND STORAGE TANK LAW 49ae ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 490-W.STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDI-ASTANDING AUTOMATIC TANK GAUGING SYSTEMS- 49049s ❑ OTHER(Specify): 490-OL. facility gnated UST e,who has 490-9i. This faeil' has °`Desi Operate passed the Califotnie UST System Operator Exam administered by the Intettrations[Code Council 496-75. (ICC). The "Designated UST Operator'will train facility employees to the proper operation and mai arcraance of the UST systems annually,and within 30 days of hire,This training will incdaxk,but is not limited to,the following: D Operation of the UST sysusms in a manner oortsisterit with the facility's best management practices. D The facility employee's role with re=gard to the monitoring equipment as specirW in this US-T Monitoring Plan. > The facility employee's role with regard m spills and overfills as specified in the facility's UST Response Plan. D Narnc(s)of conte persons)for emazoncics and monitoring alarms. :.: Provide adQitional comments here or indicate how many pages with additional infot7tt8t(an on specific monitoring pr arcs are stanched to this plan. 49E,-7t. The UST Ot ner/Operstpr is responsible for ensuring that: ].)the dailyhqutine TJSI'monRaring aceiviiies and nrWintenartce f UST leak do cction unn by a 1>Tan occurs;2.)all Conditions that indim a pomible release are investigalyo d;and 3.)all monitorinnyrcCords arc ra�intaif U properly It covered THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOIL PERFORMING THE MONITORING AND EQUIPMENT MAIN'TENANCI:: NAME: 690.E Z � .� TITLE: /i,Sfl . -mar— a9r`7s. NAME: 496.74. 490,7s. The Designated UST Operator shall perform a monthly visual inspection of the facility,provide a report to the owner/operator,and inform Vie owncr/operator ofany conditions that rid fbilow-up action. CILRTERCATIO•N:I certify that the Wo0hation Provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 4W77REPM . b'NTAIG:Q t.Tak ❑3.A GYivo d' 49A76. APPLICANT NAME(print): APPLICANT 490�7"• UPCF UST-n(12,2007)..3/4 www.unId*cwrg 8T0/ 900-d 000x# 80:60 9002/ZZ/80