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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-540- 490-546 ❑ 1.CONTINUOUS ELECTRONIC MONITORING FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS 099.OTHER(Specify); PANEL MANUFACTURER: 1/ 490-55 MODEL#: °3 5- 490-56. LEAK SENSOR MANUFACTURER: da 490-57 MODEL#(S): C c-490-58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES 01b.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES db.NO 490-60 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES Yb.NO 490-61 UDC MONITORING STOPS TUE FLOW OF PRODUCT AT THE DISPENSER. da.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 ❑2.PRESSURE Q 3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490-64b-64b VII.PERIODIC SYSTEM TESTING ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC_ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23( CCR§2644.1) SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490 -66 66 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-67 VIII.RECORDKEEPING Th following monitoring/mai tenance records are kept for this facility: [Alarm logs 490-68a Visual Inspection Records 490-68b ❑Tank integrity testing results 490-68c ❑SIR testing results(and supporting documentation records). 490-68d ❑ Tank gauging results(and supporting documentation records). 490-68e ❑ATG Testing results(and supporting documentation records).490-6af ❑ Corrosion Protection 60-day logs 490-68g ❑Equipment maintenance and calibration records. 49M8h IX.TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-69a REFEjtENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-69b 0 OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-69c ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e ❑ 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):M69k 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 The facility employee's role with regard to spills and overfills as specified in the UST Response Plan A Names of contact person(s)for emergencies and monitoring alarms.490-70 X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indic many pages with additional information on specific monitoring procedures 0-r ed to this plan.490-71 � � ® C 7 M.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 properly. The following person(s)are respons}ble f r performing the monitoring and equipment maintenance: NAME f c ca 1 "®+ 490-72 TITLE w w--- 49x73 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. MI.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: 2 490-772/7 � ft stwor 13 3.&4riz RSgM0t3fivg APPLICANT NAME(print): L ] 490.76 APPLICANT TITLE: 0-900-9 fid)/ �7 �.�ne ✓ UPCF UST-D(12/2017)3/4