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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN (Page 2 of 2) <br /> VI.UNDER DISPENSER CONTAINMENT UDC MONITORING <br /> 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 49054a <br /> 0 1.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 0-90546 <br /> ❑4.NO DISPENSERS 099. "R(Specify): _ <br /> PANEL MANUFACTURER: Veeder Root 490 55 MODEL#: TLS-350R 490-56. <br /> LEAK SENSOR MANUFACTURER: Beandreau , MODEL#(S):406-508 <br /> — -- ----- ----------------- <br /> 490-67 , 490-58 <br /> DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES ®b.NO 490.59 <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES ®b.NO 490-60. <br /> FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a YES ®b.NO 490.61 <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ® a YES ❑b.NO 49062 <br /> 2.UDC CONSTRUCTION IS ®1.SINGLE-WALLED ❑ 2.DOUBLE-WALLED 490.63 <br /> IF DOUBLE WALLED: _Wo`-6`aa <br /> UDC INTERSTITIAL SPACE IS MONITORE_D_BY: ❑1.LIQUID ❑2.PRESSURE_❑3.VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490'646 <br /> VII.PERIODIC SYSTEM TESTING <br /> 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65• <br /> LEAK DETECTION(ELDI MUST BE PERFORMED. PERIODIC E_LD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR 2644.1) <br /> ®2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 <br /> ff3.SPILL BUCKETS ARE TESTED ANNUALLY. 49067 <br /> VIII:RECORDKEEPING <br /> The following monitoring/maintenance records are kept for this facility: <br /> ®Alarm logs 4go-6&a ❑Visual Inspection Records 490-6sb ❑Tank integrity testing results 49absc <br /> ❑SIR testing results(and supporting documentation records). 490.68d ❑ Tank gauging results(and supporting documentation records). 490-6se <br /> ❑ATG Testing results(and supporting documentation records).4w68f ❑ Corrosion Protection 60-day logs 49068g <br /> ®Equipment maintenance and calibration records. 490-6sh <br /> 11-TRAINING' <br /> ®Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 49"ga <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) <br /> ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)4906% <br /> ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-690 <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49069e <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION"490-69f <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"49069g <br /> ❑ OTHER(Specify):M69h,M69i <br /> This facility has a"Designated UST Operator"who has passed the Califomia UST System Operator Exam administered by the International Code Council(ICC). <br /> 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 <br /> training will include,but is not limited to,the following: <br /> ➢ Operation of the UST systems in a manner consistent with the facility's best management practices <br /> A The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan <br /> ➢ The facility employee's role with regard to spills and overfills as specified in the UST Response Plan <br /> ➢ Names of contact person(s)for emergencies and monitoring alarms.490-70 <br /> X. COMMENTS/ADDITIONAL;INFORMATION <br /> Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.490-71 <br /> Overfill Prevention is set at 90%of the tank capacity. <br /> XL;PERSONNEL RESPONSIBILITIES <br /> 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 <br /> this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. <br /> The following person(s)are responsible for performing the monitoring and equipment maintenance: <br /> NAME Mo' an Manvari 490-72 TITLE Area Manager 490-73 <br /> NAME Grant Zech 490-74TITLE Operations Manager 490-75 <br /> The Designated Operator shall perform a monthly visual inspection of the facility, provide a report to the owner/operator,and inform the owner/operator of any <br /> conditions that need follow-up action. <br /> XII,OWNlER/OPERA.TOKSIGNATURE <br /> CERTIFICATI :I certify that the' rin tion provided herein is true and accurate to the best of my knowledge. <br /> APPLICANT SIG TUBE 490-76 DATE: 490-77 <br /> February 8,2011 <br /> APPLIC ME(print): 490-78 APPLICANT TITLE: 490-79 <br /> UST Response Plan(3/2008)3/3 <br />