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08/27/2010 15:25 2093675424 BAGLEY ENTERPRISES PAGE 05/05 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (P*p 2 afZ) VI.UNDER DISPENSER CONTAINMENT(U1W)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54h I fdONTINUOUS ELECTRONIC MONITORING .0 2.FLOAT AND CHAIN ASSEMBLY [3 3,ELECTRONIC STANDALONE 4.NODISPENSERS, [399.OTHER(Specify): PANEL MANUFACTURER' LEAK SENSOR MANUFACTURER. MODEL#M: DFTRCTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAI,A r..ARm.9 YFA CJ b.NO LRX LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN E] a.YES ❑b.NO FAII,.IJRF/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS ALITOMATIC PUMP SHUTDOWN. [1 3,YES b.NO UX MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. El a.YES 0 b.NO 4an ds 2.UDC CONSTRUCTION IS [31.SINGLE-WALLED 0 2.DOUBLE-WALLED/-- IF DOUBLE WALLED: UDC ENTERSTITIAl.SPACE IS MONITORED BY: 0I.LJOW41 2.PRESSURE._ 4944 SSURE,_03,VACUlJM A LEAK WIT[4rN THE SECONDARY CONTATNMENT-CIFTlit UDC TRIGGERS AUDIBLE AND VISUAL ALARMS 13a.YES 0 b.NO VH.PERIODIC MTEM TESTING ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCE ==M12)MUST U PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCRA&j.I L___ §!CONDARV CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 41M,66 SPILL BUCKETS ARE TESTED ANNUALLY. VIII.RWORDKEEPING The aftwing monitoring/maintenance records am kept for this facility: W`Atarru logs A"., F ]Visual Inspection Records 4M. Mh ank integrity testing results 49orAc [I STA testing results(and supporting documentation records), 490ARd [3 Tank ganging results(and supporting documentation records), 4wi-me. VTmaintenance Testinit resulm(and suppftng documentation records).4W-Nr M Corrosion Protection 60-day top 49n-oox uipment. intenance avid calibration records, 4mmm 01iIX.TRAINING Vm.nnct with UST monitoring responsibifitics are familiar with all of the following documents relevant to theirjob duties. AW.Ma REFI CE DOCUMENTS MXMAINIED AT FACILITY(Check all that apply) S UNDERGROUND STORAGE TANK MONITORING PLAN(Required)ox"% M-6AERATING MANUALS FOR RLFf-7RONIC MONITORINQ,EQUIPMENT(Required)49wga CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4%69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW Aww% E] STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION; "HANDBOOK FOR TANK OWNERS MANUAL AND STAT`(STTCAL.INVENTORY RECONCMATION"mx)-w SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 0714ER(Specify)!mr,%,WA V - rhe California U1,;T Systern Operator Exam administered by the International Code Council(ICC).is fac—ifity hWilTiesignated USTOperator" R�ig riWW' The"Designated UST Operator"will train facility employ=in the proper operation and mairitcrtance orthc UST systems annually,and within 30 days or hire.This training will include,but is not limited to.the following. ;-1 Operation of the UST systems in a manner consistent with the facility's beg management practices > The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan > The racil icy employee's rale with regard to spills and overfil Is as%peci red in the U.ST Rcqpome Plan > Names of contact persons)for emergencies and monitoring alarms.49o.79 X COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this Vim,49o-yj XL PERSONNEL RESPONSIMLI'IM 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 of*investigateel.and 3)all monitoring records are maintained properly. The fallowing person(a)are responsibic for performing the monitoring and equipment maintenance; NAME 40-72 TITLE Hcsp- 490-73 NAME -- Xlfiff= 49(9-7-1 TITLE CCpTAj6a-TV#- 9bjL Sa &9w. VICW 490-75 The Designated Operator shall perform a monthly visml inspection of the facility,provide a report to the ower/operator,and inform the owner/operator of any conditions that=4 follow-up action. 3M.OVMR/OPRRATOR SIGNATIM CERTIFICATION:Lqgjithat the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGEMURE A411-7r. DATK: ov A 47 APPLICANT NAME(print): 4-X).7k APPLICANT TITLE; d90-79 -P&SPO Cry F4e HC60 IJ-PCF US-7 D(12/2007)3/4