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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54 49-546b CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHER(Specify): PANEL MANUFACTURER: --5s MODEL#: 490.56. LEAK SENSOR MANUFACTURER: 490"57 MODEL#(S): _ 490-58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS .YES ❑b.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a.YES ❑b.NO 490-60 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES [3b.NO 41 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER 9a.YES ❑b.NO 490.62 2.UDC CONSTRUCTION IS 94.SINGLE-WALLED ❑2.DOUBLE-WALLED 490-63 IF DOUBLE WALLED: 490-648 UDC INTERSTITIAL SPACE IS MONITORED BY: 1.LIQUID 2.PRESSURE 3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS JRa.YES ❑b.NO 490-641 VII.PERIODIC SYSTEM TESTING 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49x65. K DEJLQUQkU=MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1 SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49"6 SPILL BUCKETS ARE TESTED ANNUALLY. 49"7 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: lawn logs a90688 isual Inspection Records 49x686 'ty testing results a90�bsc SIR testing results(and supporting documentation records). ago 684 Tank gauging results(and supporting documentation records). 490-688 ATG Testing results(and supporting documentation rceords).x90 b8r ❑ Corrosion Protection 60-day logs 490689 Equipment maintenance and calibration records. 490-68h DL TPAINING ❑Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-698 REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) IS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490696 VCALIFORNIA ERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)49-698 UNDERGROUND STORAGE TANK REGULATIONS 490-69d LIFORNIA UNDERGROUND STORAGE TANK LAW 49-698 ❑ 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 m69t Iff-This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(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 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 ➢ 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.490.70 X. COAEMWMSIADDMONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.490-71 A 950i M.PERSONNEL RESPONSIBILITIES 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 foil g person(s)are regonsible for performing the monitoring and equipment maintenance: NAME ( x90-72 TITLE 490-73 NAME 490-74 TITLE 490-75 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 conditions that need follow-up action. XII.OWNER/OPERATOR SIGNATURE CERTIFI N:I certify that the information provided herein is true and accurate to the best of my knowledge. APtI.ICANT516NATURE 490-76 DATE: 490-77 /- 6/, 479 APPLICANT TITLE: APPLICANT NAME(prin .® 49a7s tAll