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n UNUMD PROGRAM CONSOLIDATED FORM Z3P DFAGROUND STORAGE WANK MONffORMG FLAN - e 2 of 2 Vi :UN LR DOSP NSE COW-,; INiVECNT: (UDC) M0NiTfaR TG UDC: MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ❑ 1. CONTINUOUS ELECTRONIC MONITORING ❑ 2, FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONE 49USir ❑ 4, NO DISPENSERS _ _ ❑ 99. OTHER (Specify) mx sap LEAK MONITOR MANUFACTURER: _ �. Ce.C,. f!P cd. `x= a9ass. MODEL #: aro•-sv. LEAK SLNSORMANUFACTURER:�T'91-75' a�57 MODF..L#(S):rinse. DL•TECTION OF A LEAK INTO THE UDC 17IGOERS AUDIBLE AND VISUAL ALARMS. R-4. YES ❑ b. NO 4'0-".. UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. .0'a. YES ❑ b, NO 4'xA - FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. 0-a. YES ❑ b. NO 41WI UDC MONITORING STOPS THE PLOW OF PRODUCT AT THE DISPENSER 0"a. YES ❑ b. NO 4'0-62• _ _� __._.... __ .. _... ...-._..... ...---- -.. _........ _ ... .._.._.. _..._- 490,61 UDC CONSTRUCTION LS: JR/1.1. SINGLE WAIL [32. DOUBLI: WALL -749043. iF I�IJBT.Ii WAI.I.: UDC INTERSTITIAL SPACE LS MONITORED BY: ❑ a. LIQUID ❑ b. PRESSURE ❑ c. VACUUM A LEAK WITHIN THE SECONDARY CONTAINMF,NT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a. YES ❑ b. NO "L: PEWODIC:SYS' NTE ' ❑ 1, F.LD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 4x163. LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. r23 CCR 42644.11 ® 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49W ® 3. SPILL BUCKETS ARG Ti STED ANNUALLY. 49"7� VM, RECORD KEEPING:: The following monitoring/mnintenanoe records are kept for this facility: 4'0 6C• ® a. ALARM LOGS ❑ b. VISUAL INSPECTION RECORDS ❑ c. TANK INTEGRITY TESTING RESULTS ❑ d. SIR TESTING RESULTS (and supporting documentation retards) ❑ e. TANK GAUGTNG RESI JLTS (and supporting docume=tion records) ❑ £ ATG TESTING RESULTS (anti supporting documentation records) ❑ g. CORROSION PROTECTION 60 -DAY LOGS h. EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS DL ® Personnel with UST monitoring responsibilities are familiar with all ofthe following documents relevant to their Job duties: 4-90 G9s REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Ckeek all that apply) (9 THIS UNDERGROUND STORAGE TANK MONTTORTr3G PLAN (Regvirod) 40rFnD ® OPERATING MANUALS FOR FI.1?CTRONTC MONITORING EQUIPMENT (Requb*0 490-69a. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49M9d. ❑ CALIFORNIA UNDERGROUND STORAGE TANK I A W 4MA14. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION; "HANDBOOK FOR TANK OWNERS MANUAL AND --9t. STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION: `UNDFRSTANDIlMG AUTOMATIC TANK GAUGING SYSTEMS" 490.693 ❑OTHER (SpY) . ® This facility has a "Designated UST Operator" who has passed the California UST System Operator Exam administered by the International Code Council 49-70. (ICC). The "Desigrxated UST Operator" will train facility employees in the proper operation and maintenmwe of the UST systems annually, and within 30 days ofhite. This training will inplude, but is not limited to, the following. ➢ Operatiorn of the UST systems in a manner consistent with the facility's best management practices. y 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 facility's UST Response Platt. a Name(s) of contact person(s) for en eei-genccies ., • 11.'.' admonitoing alarmsIN O , Ox 10ND]nialAyV Provide additional comments herr or indicate how many pages with addrtiot l information on specific monitoring procedures am attached to tris plan. 49V71. ... XL ...PFASONNEL USPONSIBUffhR8 The UST O-cr/Operatw is responsible for ensuring that: r.) the daily/roudne UST monitoring activities and maintenance of UST leak detection equipment covered by this plan occurs; 2. all conditions that indictee a ponsibic release are investigated; and3.) sli moniwrin records are maintained properly. THF,. FOLL ON(S) ARE RESPONSIBFOR PF,RFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME:: .�7 �ac (� � �, -0-,7. TITLE: „Lr_ _ _ 4W. 73. NAME: •��, 490-74- TITLE: 4XW5. The Designated UST Operator shall perform a monthly visual inspection Of the facility, provido a mport to the owner/operator, and inform the owner/operator of any conditions that need tollow-up action. 10k,::OWNEMPERATOR SIGNATURE CERTMCAT ION: I certify ermadoo provided herein is true and ncem ate to the best of my knowledgC, APPLICANT SIGNATURE DATE: 4'° 77• i R2PRR9EN"nfrG: a I.1Lnl• Owrax ' 'N 3. Autlruized ¢qan ve of Owner 490.7G. r 490.78. APPLICANT NAME. ( " t}; a APP LI T TITLE: -7!x179. (�lOdtdel- UPCF G,LJ UST -D (1212007) - 3/4 1 www.unidoc"rR 4:flcetive 01/17M TTO/ 9001d SL90# 0£:90 90OZ/ZZ/LO