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P, -q WKWIFIED PROGRAM CONSOLIDATED FORM Wr UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI. UNDER DISPENSER CONT NT (UDC) MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54 ab 490-54bb ❑ 1. CONTINUOUS ELECTRONIC MONITORING �t 2. FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONE ❑ 4. NO DISPENSERS ❑ 99.OTHER (Specify): PANEL MANUFACTURER: O a9ass MODEL #: 49D-56. LEAK SENSOR MANUFACTURER 490.57 1 MODEL #(S): 490.59 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a. YES 0 b. NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a. YES 10 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 W. .. 2. UDC CONSTRUCTION IS SINGLE -WALLED ❑ 2. DOUBLE -WALLED 490-63 IF DOUBLE WALLED: 490-64a UDC INTERSTITIAL SPACE IS MONITORED BY: 0 1. LIQUID 2. PRESSURE 13 3. VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a YES ❑ b. NO 490,646 VII. PERIODIC SYSTEM TESTING 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1 62. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490.66 04 SPILL BUCKETS ARE TESTED ANNUALLY. 490.67 VIII. RECORDKEEPING The following monitoring/maintenance records are kept for this facility: 93 -Alarm logs 490.68a ❑ Visual Inspection Records 490-686 Tank integrity testing results 49"& SIR testing results (and supporting documentation records). 490-M U Tank gauging results (and supporting documentation records). 49"m ATG Testing results (and supporting documentation records). 490-6&f Corrosion Protection 60 -day logs 4go-as (B -Equipment maintenance and calibration records. 490-68h IX. TRAINING ersonnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490.6% REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 49o -69b OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 4go-69c CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49o -69d CALIFORNIA UNDERGROUND STORAGE TANK LAW 4 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" 49o.69s ❑ OTHER (Specify): M69k m69i This facility has a "Designated UST Operator" who has passed the California UST System Operator Exam administered by the International Code Council (ICC). 'Me—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: A 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 A 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. 4go-7o X. CONMENTWADDITIONAL INFO TION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan. 490.71 M. PERSONNEI, RESPONSIBIIJMS 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 followi on(s) are responsible for performing the monitoring and equipment maintenance: NAME C l 4go-72 TITLE 4W73 NAME 490-74 TITLE 490-75 The Designated Operator shall perform a monthly visual inspection of the facility, provide a report to the ownedoperator, and inform the owner/operator of any conditions that need follow-up action. XII. OWNER(OPERATOR SIGNATURE CERTIFICATION: I certify that the information vided herein is true and accurate to the best of m knowledge. APPLICANT SIGNATURE 49oa6 DATE:: 490.77 l�l�l(( ol 490-79 APPLICANT NAME (print): APPLICANT TITLE: 410,79 cy� , �" D 1 ' qp-- UPCF UST -D (12/2007) 3/4