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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN — (Page 2 of 2) (Checkall VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING thataDol- UDCNIONIFORINO IS PERFORMED USING THE FOLLOWING METHODS) ❑ I C-ON-11,N't.,IOUSELECTRONIC MONi-rORIN() X 2. FLOAT AND CHAIN ASSEMBLY 0 3. F1I,EcTRONIC STAND-ALONE 0 4, NO DISPENSERS ❑ 99. OTHER (Specify) LEAK MONITOR MANUFACTURER' 4')0-55 MODEL #: 4461i6 LEAK SENSOR MANUFACTURER: 400-0 MODEL #(S): 41)0 -ss DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. 0 a. Y FS X b. NO UDC LEAK ALARM -TRIGGERS AUTOMATIC PUMP siLuTDOWN. 0 a. YES X b, NO FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTIX)WN. 0 a. YES X b. NO 490-61 UDC MONITORING STOPSTHE FLOW OF PRODUCT AT THE DISPENSER. X a. YES 0 b, No UDC CONSTRUCTION IS: X 1, SINGLE WALL 0 2, DOUBLE WALL II DOUBLE WALL: 49(t -64a UDC INTERSTITIAL SPACE IS MONITORED BY: 0 a. LIQUID 0 b. PRESSURE 0 c. VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. 0 a. YES 0 b. NO 4AL64b VII. PERIODIC SYSTEM TESTING 0 1 ELD TESTING:"PHIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT EN'HAN __( J -_f ) 4904,5 LEAK Ik,--,TELTIQN LI) MUS PERFORMED. PERIODIC ELDIS PERFORMED EVERY 36 MONTHS AS REQUIRED. f2-3CCR s--644 11 (L 2. SECONDARY CONTAINMENT COMPONENTS -ARE TESTED EVERY 36 MONTHS. 490-60, 1 SPILL BUCKETS ARF 'TESTED ANNUALLY, 41)0,67 VIII, RECORD KEEPING The following monitoring/maintenance records are kept for this facility 49n,68 0 a AI ARM LOGS 0 b. VISUAL INSPECTION RECORDS 0 c.TANK IN-rECRI'FY-TESTING RESULTS 0 d. SIRTESTING RESULTS (and supporting documentation records) 0 e. TANK GAUGING RESULTS (and supporting documentation records) ❑ f, AICs TES TING RESULTS (and supporting documentation records) ❑ g. CORROSION PROTECTION 60 -DAY I,O(',iS h- FQUIPMFNT MAINTENANCE AND CALIBRATION RECORDS IX TRAINING Z Personnel with usi monitoring responsibilities are familiar with all of the following documents relevant to their job done,,;: 4W-69. REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that appli,) 0 THIS UNDERGROUNDSTORAGE TANK MONITORING PLAN (Required) 49CW58b i El OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 490-69� 1 El CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d El CALIFORNIA UNDERGROUND STORAGE TANK LAW 490,b,)e 0 STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: -HANDBOOK FOR TANK OWNERS MANUAL AND 490-69f STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION. "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS - 490-6,)g C3 OTIIER (Speclfv): 490�6400-0h 9i "Designated UST Operator" who has passed the California UST System Operator Exam administered by the International Code Council This facilitv has a "Desi W,, 4 -70 (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 LIST 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 facility's UST Response Plan. Name(s) of contact person(s) for emergencies and monitoring alarms. X COMMENTSIADDITtONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan, 490-71 I® PERSONNEL RESPONSIBILITIES The USTOwncr/Operator is responsible for ensuring that. 1.) the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered ,byjIns plan occum, �p sible release are i ves�ga!eiq- maintained e _properly, THE FOLLOWING PERSON(S) ARE REErySPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: Grace Keller 490-72 TITLE: Manager 490-73 NAME: Sandy Edwards 4"-74 TITLE: Environmental Compliance Admin. 49* -75 The Designated EST 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. OWNER/OPERATORSIGNATURE CERTIFICATION: I certify that the informationprovided herein is true and accurate to the best of my knowledge. —11�- APPLICANT SIGNATURF(---, DATE: 71 2/8/2010 REPRESENTING X I T�O.ner. Oper ator 0 2 Facilliv 0.,ne,,'Operato, 3_ Authorized Regre—Wi,e of0— 490.76. I UPCF us,r-D (1212007) - 315 ww-w.unidocs.org