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NIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. U C MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54b 490-546 61.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHER(Specify): PANEL MANUFACTURER: 490 55 MODEL#: 490.56. LEAK SENSOR MANUFACTURER: VIF6.b E K RG c'(. 490-57 . MODEL#(S): 001 490-59 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS .YES 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN Wa.YES pyrr� 490.60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. Wt.YES ❑.WNO 490-61 UDC MONITORING STOPS THE LOW OF PRODUCT AT THE DISPENSER Ula.YES ❑b.NO 490-62 2.UDC CONSTRUCTION IS 1.SINGLE-WALLED ❑2.DOUBLE-WALLED 490-63 IF DOUBLE WALLED: 490-64a UDC INTERSTITIAL SPACE IS MONITORED BY: 1.LIQUID 02.PRESSURE 0 3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490.646 VII.PERIODIC SYSTEM TESTING 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49065. LEAK DETECTION MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1 WISECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490.66 SPILL BUCKETS ARE TESTED ANNUALLY. 490.67 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: ❑Alarm logs 490(9a ❑Visual Inspection Records 490.696 ❑Tank integrity testing results 490.68o ❑SIR testing results(and supporting documentation records). 490.68d ❑ Tank gauging results(and supporting documentation records). 49o-69e ❑ATG Testing results(and supporting documentation records).49o-6sf ❑ Corrosion Protection 60-day logs 490-bag ❑Equipment maintenance and calibrdion records. 49"sh IX.TRAINING ❑Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490469a REFUENCE DOCUMENTS MAINTAINED AT FACILITY'(Check all that apply) ©"THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490.69b Q"OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-69c ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49"% ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490-69f ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-69g ❑ 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(ICC). 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 Y 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.490-70 X. COMMENTS/ADDITIONAL INFORMATION Provide additional comm is here or indicate ow any pages with additional information on specific monitoring procedures are attached to this plan.490-71 �.G -�'n FIQ�Pe� M.P#RSONNEL 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 properly. The following person(s)are responsible for performing the monitoring and equipment maintenance: NAME 49o-72 TITLE 490-73 NAME 490.74 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. XII.OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE 490.76 DATE: 490-77 RgPRFSOMLQ O 1.Tank CMmu Operator❑2.Faeility OwnedOcerator 3.Authorized Representative of Owner APPLICANT NAME(print): 490-78 APPLICANT TITLE: 490-79 UPCF UST-D(12/2007)3/4