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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN — tPaS 2 of 22 Vt. UNDERDISPENSER CONTAINMENT (tJDC) MONITORING that awl UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) El 1. CON'l INUOUS ELECTRONIC MONITORING X 2. FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONE 496-54a T. NO DISPENSERS El 99, OTHER (Specify) 4W)-54b LEAK MONITOR MANUFACTURER: MODEL LEAK SENSOR MANUFACTURER: 4'30.57 MODFI.4 #(S): 490-58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. If a. YES X b. No 41111-11) UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN, 0 a. YES X b. NO """f) FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SI IUTDOWN. [I a. YES X b. No 490-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. X a. YES [3 b. NO UDC CONSTRUCTION IS: X 1, SINGLE WALL 0 2. DOUBLE WALL 490-63 tL_DOUBLE At_kLL: 490.64. UDC INTERSTITIAL SPACE IS MONITORED BY: Ela. LIQUID b. PRESSURE ❑ c. VACUUM A LEAK wiTHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. 0 a. YES 0 K NO 1110-0b VII. PERIODIC SYSTEM TESTING -rFsTiNG ❑ I. FED FRE FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANM 490-65 LEA11 . . ... LLA&zjQjLFj1'LLLL1j102UjLM MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REgUIRED, 2 SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 440-66 3. SPILL BUCKETS ARE TESTED ANNUALLY. 4'XJ-67 VIII. RECORD KEEPING ' The following nionitoring/maintenance records are kept for this facility: 4W-68 0 a. ALARM LOGS El b. VISUAL INSPECTION RECORDS 0 c. TANK INTEGRITY TESTING RESULTS [I d_SIR TESTING RESULTS (and supporting documentation records) ❑ c. TANK GAUGING RESULTS (and supporting documentation records) 0 f ATG TESTING RESULTS (and supporting documentation records) ❑ g, CORROSION PROTECTION 60-DAY LOGS 0 h, EQUIPMENT IPMENT MAINTE NANCE AND CALIBRATION RECORDS IX TRAINING 0 Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: REFERENCE UMENTS MAINTAINED AT FACILITY (Check at! that apply,) 0 THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 490_69b 0 OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 490-60c C3 CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-64d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS MANUAL AND 490-6911 s rATIS I ICAL INVENTORY ' NTORY RECONCILIATION" ❑ SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 4q0-699 ❑ OTHER (Specify)- 490-696 490_69i This facility has a "Designated UST Operator" who has passed the California UST System Operator Exam administered by the International Code Council 4110-70 (ICC). The "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST systems annually, and within 30 days ofhire. "Chis training will include, but is not limited to, the following: > Operation of the UST systems in a manner consistent with the facility's best management practices. v The facility employee's role with regard to the monitoring equipment as specified in this us,r 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 alums. X COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan. 490-_71 Mechanical overfill X1. PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that: L) the daily/routine UST monitoring activities and maintenance of LIST 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 FOLLOWING PERSON(S) ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE NAME: Grace Keller 490,72 TITLE: 490-73 NAME: Sandy Edwards 490-74 TITLE: Environmental Compliance Admin. 49()-75 *The Designated UST 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/OPERATOR SIGNATURE CERTIFICATION: I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE — C2, C'' jot DATE! 490-77 ��c� 2/8/2010 REPRESUNI INC, X I Tank 0.nW() �4�0.76f UPCIF UST -D (12/2007) - 315 www.unidocs.org