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i 6 <br /> Underground Storage Tank Monitoring Plan-Page 2 of 2 <br /> VI. DISPENSER MONITORING <br /> MONITORING OF AREAS BENEATH DISPENSER(S)IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) M50. <br /> ❑ 1.CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT(UDC) <br /> PANEL MANUFACTURER: M51. MODEL#: M52. <br /> LEAK SENSOR MANUFACTURER: M53. MODEL#(S): M54. <br /> WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ❑ a.YES ❑ b.NO M55. <br /> WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M56. <br /> WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M57. <br /> ® 2.MECHANICAL ASSEMBLY(e.g.,FLOAT AND CHAIN ASSEMBLY)IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK <br /> ASSEMBLY MANUFACTURER: Bravo Msa MODEL#(S): 82000-879-G3W,B2000-879-DlUl M59. <br /> ❑ 3.VISUAL MONITORING DONE: ❑ a.DAILY ❑ b.WEEKLY(Requires agency approval) M60. <br /> ❑ 4.NO DISPENSERS <br /> ❑ 99.OTHER(Specify) M61. <br /> VII. ENHANCED LEAK DETECTION <br /> ❑ 1.WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK M7o. <br /> DETECTION(ELD)FOR THE UST(S)COVERED BY THIS PLAN.PER 23 CCR§2644.1,ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED <br /> VIII. TRAINING <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) Mao. <br /> 1. ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) <br /> 2. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) <br /> 3. ® THE FACILITY'S BEST MANAGEMENT PRACTICES(Required as of January 1,2005) <br /> 4. ® CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS <br /> 5. ® CALIFORNIA UNDERGROUND STORAGE TANK LAW <br /> 6. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION" <br /> 7. ❑ SWRCB PUBLICATION:"WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" <br /> 99. ❑ OTHER(Specify): Mgl. <br /> Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those documents when needed. <br /> By January 1,2005,this facility will have a"Designated UST Operator"who has passed the California UST Sytem Operator Exam administered by the International <br /> Code Council(ICC). By July 1,2005,and annually thereafter,the "Designated UST Operator"will train facility employees in the proper operation and maintenance <br /> of the UST systems.This training will include,but is not limited to,the following: <br /> ➢ Operation of the UST systems in a manner consistent with the facility's best management practices. <br /> ➢ The facility employee's role with regard to the leak detection equipment. <br /> ➢ The facility employee's role with regard to spills and overfills. <br /> ➢ Whom to contact for emergencies and leak detection alarms. <br /> For facility employees hired on or after July 1,2005,the initial training wil I be conducted within 30 days of the date of hire. <br /> IX. COMMENTS/ADDITIONAL INFORMATION <br /> Please use this section to include any additional UST system monitoring-related information(e.g.,additional information required by your local agency): Mss. <br /> Note regarding Section X.Pending certification of a Designated UST Operator,the following person has authority for performing the monitoring <br /> activities and maintaining leak detection equipment covered by this plan. <br /> NAME: JOB TITLE: <br /> X. PERSONNEL RESPONSIBILITIES <br /> AS OF JANUARY 1, 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT <br /> APPLICATION-FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING <br /> LEAK DETECTION EQUIPMENT COVERED BY THIS PLAN,AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS <br /> OF THE FACILITY'S UST SYSTEMS IN ACCORDANCE WITH 23 CCR§2715(b). <br /> XI. OWNER/OPERATOR SIGNATURE <br /> CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> OWNER/OPERATOR SIQNATURIZ REPRESENTING DATE: M91. <br /> ❑Owner M90. <br /> CS Operator 10 1-4Al p <br /> OWNER/OPERATOR NAME Tint): M92. OWNER/OPERATOR TITLE:Department Head, M93. <br /> C. SUSI Jackson Environmental Protection Department <br /> (Agency Use Only) This plan has been reviewed and: ❑Approved ❑Approved With Conditions ❑Disapproved <br /> Local Agency Signature: Date: <br /> Comments/Special Conditions: <br /> UN-022A-2/6 www.unidocs.org Rev.10/14/03 <br />