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UNIFIt',113 PROGRAM CONSOLIDATED FORM
<br /> U I NDERGROUND STORAGE TANK
<br /> MONITORING PLAN — (Pave 2 of 2)
<br /> (Check UP
<br /> V1. UNDER DISPENSER CONTAINMENT(UDC)MONITORING thal mm'dLo,
<br /> [3 i coNtim,(>us f-.'I,ECTR0NI(, MON I FOR INO 02,f7f,.OA'T-ANI)CfIAIN'ASSE.N4B[,Y [1 .1,ELECTRONIC STAND-ALONF
<br /> 0 "o clisr'E'sSERS 0 94.01-HER(Spccify)
<br /> I FAK MONITOR MAN U FAC TURER: MODEL 4:
<br /> LE AK SENSOR MANU FACT URI.,..R' a MODEL 1:'(S):
<br /> DI I H'T ION OF A LEAK INTO I HE TRIGGERS AE 0113I.Ci AND VISUAL ALARMS- C3 a,YF�s 0 b NO
<br /> F
<br /> D( IJAK ALARM IR16GRS Atal'OtNIAT'ICPL;lIPS[fL!']'DYE
<br /> OWN. M a, S [] b,NO
<br /> AILL,RE,DISCONNECTION OF UIX'VION1 FORING SYSTEM TRIGGERS A(.'T(.)MATK'P(,)MP SHUTDOWN, E] a,YES C3 b NO "1-,1,
<br /> I DCk10\ITORI\(;STOPS FliF FLO'lVOF PRODUCT AT THE DISPENSER, YES [3 K NO
<br /> tAX (-'(-,)\STkUCTION IS: E3 1.SINCLE WALL 0 2 DOUBLE WALL.
<br /> ill-DtA-BI FLL�LALLI
<br /> t 1X'IN'l ERS ITI IAL SPACE IS N40\1TORED BY: a.I'lot-113 0 tt.PRESSURE c VACUUSA
<br /> I[AK %Vl HH\ HIE SECONDARYCON'I AINME\1-OFTHE UDCTRI(.X.jFRS AUDIBLE AND VISUAL ALARMS, a,YES [3 b, NO
<br /> VII. PERIODIC SVSTEM TESTING
<br /> I IN-0—TEAS FACILITY I-]AS BEEN NOTIFIED BY THE S t ATE WA I FR RESOURCES CO's I ROL BOARD FHA I LNIIANC E
<br /> PERIODIC CLCD IS PERFORMED EVERY 36 MONTHS AS REgUIRED,
<br /> Z 2. SICONDARYC'0NTAI`s.MFNT COMPONENTS ARFTF15,TFD EVERY 36 MONTHS.
<br /> I S'PlIA BUCKETS ARE TFs-rED ANNUAIA Y.
<br /> VIII. RECORD KEEPING
<br /> it ALARM LOGS D b.VISUAL INSPECTION RECORDS TANK INTEGRITY TESTING RESULTS
<br /> SIR SI IN(i RESULr,(andsuotindocumentation newt lE ® c.TANK GAUGING RESULTS(and recortisl
<br /> 1.ATGTT,-STING RESULTS tan<isupponing documentation records) F1 g,CORROSION PROTECTION W-DAY LOGS
<br /> 1) jxQ('II1',jF Nt MAINTENANC-l"AND(7ALIBRATION RECORDS
<br /> IX. TRAINING
<br /> flcl ,mnd ith UST morliloring re,ponsibijilics are f'ilnfliak with all of the RAlowing docwnems relevant to thcir job duiics: 77-7
<br /> R1 F I R IXXJ'MFSTS MAINTAINED AT FACILITY t('IwcA all thw app4ij
<br /> I[IIS t,\DFR6ROIPLAN(Required)
<br /> OPERA I ING MANiJALS FOR ELI.,,CTRONICNIONITORING EQL11P%,AEN-1(Required) T", k
<br /> El (ALIFORN IA UNDER6ROUND STORAGL TANK REGULATION'S ;14,9d
<br /> C] CALIFORNIA I.iNDF.R(,-iROUND STORAGE IAN LAW
<br /> C] SI ATE WAIER RESOURCES CONIROL BOARD (SWRC'8j PUBLICATION: -HANDBOOK FOR TANK OWNERS MANUAL AND
<br /> S IA I IS Ill-'"At.INVEN IORY RECONCILIAl ION"
<br /> 0 SWRCB PUBLIC ATION:"UNDFRSTANDING At.'TOMATICTANK GAUGING SYS f'EMS- Ou,4,t
<br /> 0 (,)I k I I"R Spcci fv)
<br /> Titis
<br /> i'L,:ility ha<a-Dk-,ig:nated UISTOperatoe'%ho has passed the California UST System Operator Exam administered by the International CcKie Council
<br /> (ICC,. I he -Doignaicd UST'OperatoC will train facility employees in the ptiaper operation and maintenance of the UST System annually,and within 10
<br /> days offitiv,I his trag ininwill include,but is not limited 1-o,the itillowifllzr
<br /> Operation of the LST-syslerns in a wall the facility�s best mallagentent practices,
<br /> I "Cite i1leilltv employee's Title with in this UST Monitoring Plan.
<br /> the l1111y c,rnployee',role with vegard tozpi!is and o,cdi Its as,,pceified in the facifity,LIST Response Plan.
<br /> X. COMMENTS/ADDITIONAL INFORMATION
<br /> or ndl W I e with additional inhvil 11 Allis Inn' if(,,-du 'arca(Lac -1 to till.,plan.'a e
<br /> 2f 1A.A 4'r V, '01
<br /> I 41r
<br /> XI. PFR90NT�tL RESPONSIBILITIES
<br /> The IST Owner,Orclatoi is rcvTx)wlsible forell"'Illing that: I')the djjIv lintlinc US I'monitoring activities and maintenance of UST leak detection equipmoll:covered
<br /> hl this plop occur,�1)all conditions that imiteatc a la(�ssjbjc release are jnvcsdptc.,d,and 3_l all utimitonng records are maintained Properly,
<br /> I HII,I'OLLOW'ING PFRSONiS)ARE RESPONSIBLE FOR PERFORMING I HE MONITORING AND EOUIPMENTNIAINTENANCE:
<br /> TITLE:Supervisor
<br /> I -AMI: Jeff Mattson
<br /> TITI E� '0
<br /> L'Sl Operator shall perfonva monthly visual inspection of the facility,pmvidca re1xin to the ownerloperator,and atfotrt 1
<br /> :""Jown,That nvcJ Iollow-up acnon,
<br /> XII. OW SIGNATURE
<br /> CERTIFIC'ATION,I certify that
<br /> the i4srin vided herein is true and accurate to the best of n1v
<br /> C
<br /> 7wl
<br /> DATE
<br /> 9/4/2006
<br /> M FKI:"F%i INA
<br /> APPLICANI NAME(prim) 4'1'
<br /> APPLICANTTITLE�
<br /> Fej
<br /> -2ac N?l
<br /> 1!!
<br /> -- _!���Ve�rizonnm
<br /> . Evironental Manager
<br /> __
<br /> UPCIF US-I'-D(12,12007)_114
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