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s <br />0 <br />2t BUSINESS NAME FACILITY # DATE <br />RAMOS OIL - FRENCH CAMP �FA0006898 <br />22 <br />Name /Title of Party 1: BRYAN JONSON <br />E] routine monitoring ® maintenance of monitoring records <br />.............................. 1111.... .......... :.. ..._........... 11.11..... ........__..... <br />Duties: equipment inspections & record-keeping ® problem & alarm I leak reporting <br />................................... ... 1111 ... 11.1.1 ......... ............ ..........._.... .1111... ....1111...... .....1111.. . <br />® scheduling annual equipment certification &/or tightness testing <br />Name /Title of Party 2: SAM DELGADO <br />Person(s) responsible for :...................................... ............................................... .................... ................. ......................... ................................................................................... ................................ ................. ........................................................ ..................................... ............ ...... ........... <br />monitoring duties and ® routine monitoring maintenance of monitoring records <br />.................................................... <br />equipment maintenance / Duties: ® equipment inspections & record-keeping problem & alarm I leak reporting <br />operation:.......... ...................... ......................... .. ..................... ................ ............................ ............................ . <br />F] scheduling annual equipment certification &/or tightness testing <br />Name / Title of Party 3: <br />routine monitoring <br />E] maintenance of monitoring records <br />._........... ._......................... _............................................................. ..... .. .. ...... .. . _........ ............. _1.111.._........... <br />Duties: E]equipment inspections & record-keeping problem & alarm I leak reporting <br />scheduling annual equipment certification &/or tightness testing <br />24 <br />Type dfRepor When Due_ <br />........................ ....... ............................ 1.... ... ..11..11. .. 1..111. .._ ... . <br />® Unauthorized Release Report 24 hours initial notification; 5 days for written report <br />................................ ................_._................... ....................... ................. .......................... ........... ..,........ .. <br />® Tank Tightness Testing Report within 30 days of test or annually if system generated <br />.................................. ................................................ ........ ............ ................................. ....................................... ......_.................... <br />.......... ......... .......... ._....................... ....................................._................ ............... ............. ............................................... .......... ............ <br />® Annual Monitoring System Certification /Test Report annually; within 30 days of test/ evaluation <br />............................................................................................................................... <br />Annual Statistical Inventory Reconciliation Summary <br />Report <br />............................................................................................................................................ _. . ...................... .................................... <br />Indicate which monitoring ® Line Tightness Testing Report <br />reports will be sent to our format is: M printed from monitoring system <br />office (Hazardous Materials ® independent third party report <br />Division): <br />.............................. ....................................._.................... ....._......................_...._...................... ._._.............. <br />.......................................... <br />Annual Automatic Tank Gauging Summary Report <br />................................................... _....... ..................... _............. _......................... _...... _............. ......................... ................................ <br />Annual Monitoring Alarm Events Summary Report <br />................................................._..................._...._._...._._................_...._.._.-.._..............................._._.......................... <br />Combined Monitoring Log and Annual Summary Report <br />................................................_.......... ........................... _.............................. ......._........ .............................................. ..... ............... <br />Third Party Monitoring Annual Summary Report <br />................................................................................................................................................................1111........................... <br />Cathodic Protection Report <br />............................................ 1...1.............1.1.... .. ................................1.1.1.1.. ..... .. ... <br />❑ 60 Day Impressed Current Log <br />List any attachments to this document here: <br />annually; within 30 days of receipt from SIR contractor <br />within 30 days of test <br />annually; within 30 days after end of report period <br />..................................................................................................................................................1.11.......1.................. <br />annually; within 30 days after end of report period <br />............................ .............................. .... ................................. .................I........... _................ _......... <br />annually; within 30 days after end of report period <br />............. .................................. ................................... ................ ..........___ ............. 1111... ............ _ I.............. <br />annually; within 30 days after end of report period <br />................................. .........-................. .........................,............................................... . <br />within 30 days of test <br />.1...111. ---....1.-...-..1-.. ..... 1 ................ <br />annually; within 30 days after end of report period <br />............................................................................................................................. <br />Page Mfg 3 UST Monitoring Tari <br />