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0 0 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING I. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 49034a MI.CONTINUOUS ELECTRONIC MONITORING 0 2.FLOAT AND CHAIN ASSEMBLY 0 3.ELECTRONIC STAND-ALONE 490-54b El 4.NO DISPENSERS Q 99.OTHER(Specify): PANEL MANUFACTURER: 4 f55:T MODEL 9- T -3�� 490-5& &-c. 13 LEAK SENSOR MANUFACTURER: po 4110-57 1 MODEL#(S): :79�L % 49M9 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS 6a a.YES 0 b.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWNa.YES 0 b.NO 490-60 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES 0 b.NO 49"1 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER- t,YES [Ab.NO 49x62 2.UDC CONSTRUCTION IS fALSINGLE-WALLED 02.DOUBLE-WALLED 490-63 IF DOUBLE WALLED: 490-64a UDC INTERSTITIAL SPACE IS MONITORED BY: [:11.LIQUID El 2.PRESSURE 0 3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS Oa.YES Ob-NO 49"4b VII.PERIODIC SYSTEM TESTING El 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49"5 LEAK DETECTION(ELD)MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR 2644.1 SECONDARY2. 90 CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 4 -66 W3_SPILL BUCKETS ARE TESTED ANNUALLY, 490.67 VM.IMCOPJDKEEPING The following monitoring/maintenance records are kept for this facility: Alarm logs 490-bM [I Visual Inspection Records 4%-Mb 0 Tank integrity testing results 49o-6sc SIR testing results(and supporting documentation records). 490-ad 0 Tank gauging results(and supporting documentation records). 4w-68e ATG Testing results(and supporting documentation records).490-6sf 0 Corrosion Protection 60-day logs 490-69g Equipment maintenance and calibration records. 490-68h IX.TRAINING El Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-69a REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)49"96 OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)49&-69c 0 CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d 0 CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69C ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"49o-69f C3 SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-69g [I OTHER(Specify):m69h,m69i This facility has a-Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council([CC). The"Designated UST Operator"will train facility employees in the proper operation and maintenance of the UST systems annually,and within 30 days of hire.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 > The facility employee's role with regard to spills and overfills as specified in the UST Response Plan > Names of contact person(s)for emergencies and monitoring alarms.49ri-7o X COACM[ENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures' are attached to this plan.49x71 qo N1.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 records are maintained property. The follovAl rson(s)are responsible for pe renin he monitoring and equipment maintenance, NAME 49o-72 TITLE A5/1 C9A_ 490-73 NAME 49o-74 TITLE 490-75 The Designated 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. MI.OWNERIOPERATOR SIGNATURE CERTIFICATION:I certify thia the information pE2�Ved herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE 490-77 a 490-76 DATE: yy/ 0 C/ ® 712-61 3. PEPRESENMQ 0 1, _Eagilih,OwnedORRr 3.AWh2dpgRWrZ0ajiVe0f0Umr APPLICANT NA 47,f�7'If 490-79 APPLICANT TITLE: 49D-79 V UPCF UST-D(12/207)3/4