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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 490-54 490-546b ❑ 1.CONTINUOUS ELECTRONIC MONITORING 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS EJ99_OTHER(Specify): —----------------- - -------------------------------------------------- 490-55 - - ------------- — - -- - PANEL MANUFACTURER: MODEL#: 490-56. ---------------------------------------------------------------------------- -------------------------------------- LEAK SENSOR MANUFACTURER: ago-s7 1 MODEL#(S): 490-58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUBVIBLE AND VISUAL ALARMS ❑ a.YES b.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES ®b.NO 490-60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES b.NO 490-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ® a.YES ❑b.NO 490-62 2.UDC CONSTRUCTION IS ❑1.SINGLE-WALLED ❑2.DOUBLE-WALLED 490-63 IF DOUBLE WALLED: 490-640- -UDC INTERSTITIAL SPACE IS MONITORED BY:_[]1.LIQUID [12.PRESSURE ❑3 VACUUM — ------------------------------ — ----------- A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490-64b 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 X23 CCR$2644.1 [�2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS.--- ---------- -- - - - 490.66 L 3 SPILBUCKETS ARE TESTED ANNUALLY 49x67 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: ❑Alarm logs 490-68a N Visual Inspection Records 490-68b ❑Tank integrity testing results 490-68o ❑SIR testing results(and supporting documentation records). 490-68d ❑ Tank gauging results(and supporting documentation records). 490-68e ($�ATG Testing results(and supporting documentation records).490-68f ❑ Corrosion Protection 60-day logs 490-68g ®Equipment maintenance and calibration records. 490-68h IX.TRAINING R,Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-69. REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-69b OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-69c CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d [� CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-6% 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 N_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 ➢ Names of contact person(s)for emergencies and monitoring alarms.490-70 X. COMMENTSADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.490-71 U✓�r�i �l -F4GU,!,.-t-�itNj jD -provi e-,_A by -�Lp-per ucs '1n f0 i-x, Flcx,� XI.PERSONNEL RESPONSI ILITIES 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 responsible for performing the monitoring and equipment maintenance: NAME 4G6 490-72 TITLE 490-73 NAME <`ti 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.OWNEItKWERATOR SIGNATURE CERTIFICATION:I certify tha he information provided herein is true and accurate to the best of my knowledge. APPLi ANT SI NATURE 490.76 DATE: 490-77 V!z 4-1c)17 REPRE ENTIN 1.T�Qwner/QD�eratorElFacili Owner/O erat r M 3.Authorized Re resentative of 0—er APPLICAN AME(print): 490-78 APPLICANT TITLE: 490-79 I&L le NZ Ij l UPCF UST-D(12/2007)3/4 •,�fr b-r