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IFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VT. UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54a C31.CONTINUOUS ELECTRONIC MONITORING ; 2.FLOAT AND CHAIN ASSEMBLY M 3.ELECTRONIC STAND-ALONE 490s41, ❑4.NO DISPENSERS E399.OTHER S - -_ -1 lle�ltfK)------------------------------------------------------------- -- ------ PANEL MANUFACTURER: ------- --------------------------------------------------- ------ —------------------------------------------------------—---------—----------—------ MODEL 9: 400-56 LEAK SENSOR MANUFACTURER: 490-57I _--------------------------------------------------------- I MODEL#(S): DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS E3 a.YES b.NO 490-5° UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN J&a.YES 0 b.NO 49MO, FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES W.NO 41M.61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. a YES R b.NO 2.UDC CONSTRUCTION IS XI,SINGLE-WALLED []2.DOUBLE-WALLED IF DOUBLE WALLED: UDCINTERSTITIAI SPACE IS_MO_NITOREDBY:__Q_j, El -------- ----------------- _jtIQUID E 2. PRESSURE 3.VACUUM ------------ --------------------- ------------------------------------------------------------------------- -A LEAK WITHIN THE SECONDARY CONTAINMENT THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS Ela.YES Ob.NO 4')0-64b VII. PERIODIC SYSTEM TESTING Lj 1. ELD TESTING: THIS FACILITY HAS BEEN OTIFI _LEA D ED BY THE STATE WATER RESOURCES CONTROLARD THAT ENHANCED 4')0-6S �T]�C ---------- TION(ELD MUST A _D. PERIODIC ELD-I-S-PER-FORMED-EV-ERY-36-MONTHS_ S- ------E_UIR!�P_-(2_3_CCR.§26_44.1) X1 SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY36MONTHS 490-66 ..................j---------------------------------------- ---------------------------------------------------------------------------------- 490-67 VIII.RECORDKEEPING — fo'lowm�m,,,, The following monitoring/mainteriance records are kept for this—facility Ig The logs 49M8, %ViSLI21 Inspection Records 490-68b n Tank integrity testing results 490-68c SIR testing results(and supporting documentation records), 490.69d n Tank gauging results(and supporting documentation records). 490-68e ATG Testing results(and supporting documentation records).490-68r El Corrosion Protection 60-day 109S 490-68g Equipment maintenance and calibration records. 490-68h IX TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their duties.? 490 6 EFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) -9, 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 0 CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e D STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490-69f 1:1 SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490.69g 0 OTHER(Specify):M69h,M69i This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered b he Designated UST Operator"will train facility employees ill the Proper operation and maintenance of the LIST systems annually,and within 30 days of hire.This training will include,but is not limited to,the following: Code Council(ICC), > 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 P, contact person(s)for emergencies X. COMMENTS/ADDITIONAL INFORMATION Provide o v:_..:dL:ad�idl,,o tl I'll,comm information oil specific;in 011i101`1 119 procedures are attached to this plan.490-n tuft�0 r7 VV� X1.PERSONNEL RESPONSIBILITIES r ope r7this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly, ent covered by The USTOwner/Operator is responsible for ensuring that 1)thedaily/routine USTmonitoringactivitics and maintenance of UST leak detection equipment 'File following person(s)are responsible for performing the monitoring - N NAME ng and equipment maintenance: NAME LA'T L=4\ 49o-7b<TITLE 490-74;cTITLE 490-73 The Designated Operator shall perform a monthly visual inspection of the ficility, provide a report to the owner/operator, and inform the owner/operator of anv conditions that need follow-up action, de additional comments here or indicate h-1111,T1,1111 ——————T— P1191.1mhaddltl0nal ?V&-han I d"con '�hc following person(s) are NAME NAME The Designated Operator h, , it'. 'ond n,that need follow_. Er/,,per,,)r an, X11.OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best f my PPLICA SIGNATUR 400-76 DATE: At .190-77 APPLICANT NAME(print): 490.78 APPLICANT TITLE: 400-79