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(TIRED PROGRAM COMSOLIDATED FORM <br /> UNDERG ROUND STORAGE TANK <br /> MONITORING PLANPaL0 of 2) n-j kall <br /> VI.UNDER DISPENSER.CONTAINMENT (UDC}MONITORING t(Chechat 4"101 <br /> UrX.'MONITORING IS PERFORMED USING;THE FOLLOWING MFTHOD(S) 3 ELECYRONICSTAND-AWNE <br /> M 1,CONTINUOUS E LECI RON IC MON[TORING 2.FLOAT CHAIN ASSEMBLY <br /> 1 1 4.NO DISPENSERS ❑ 99.o'n IHR(Specify) <br /> 55 <br /> 400- . <br /> LEAK MONITOR MANUFACTURER: MODEL 49o-56. <br /> - <br /> LEAK SENSOR MANUFACTURI,.-R: 1 <br /> Q1 <br /> -i7MODFI.#(S): <br /> DFTEC711ON OVA I.FAK INTO*rm LJLX: I-HICKJhKS AUDILILL ANL)VISUAI,AI.ARMS. YES Ef b.NO <br /> 11DC LEAK AI..ARM TRICOLKS AUTOMA'ric POMP SIIIJTDOWN. YES [I b.NO <br /> VAILURF/DISCONN1,;CTION OF UDC MONITORING SYSTEM TRIGGbWS AUTUMAXIC PUMP SHUTDOWN. ❑ a,YFs Q b.No <br /> UDC MONITORING STOPSTFIL FLOW I A I I H11,L)ISFIASUR a.YE3 ❑ b.No <br /> . .............I.......... ......... .. <br /> InN Is M 2.DOLIBLI,WALL <br /> IJDC CONS]KU 1.SINGLL WALL 41XI-64f, <br /> IF DOOBLE WALL: <br /> UDC INTLIX'S,rrI'IAL SPACF IF,N101,11TORUL)BY. C] si.LIQUID E:] h.TIR F.eql IR F 0 c.VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT'OF T111 LJOC VRIGGER-S AUDIBLE AND VISLIAI,ALARMS. El a.Yl-i's' E] b.NO 4W-64b. <br /> VII. iiiiiii-66ic SYSTEM TESTING <br /> 1. CI,D TFSTINCL 014M1j—I.-ACILITV IIAS SPLN NOTIP113.0 RV Till: KTA*rr WATFR Rl;,1',0IJIZCF.q CONTROL BOARD THAT ENHANCED 491W,5 <br /> I.F.A-KDF-rEgrlo.N,(LLL))MI.ISTBF,PERFORML-1). PERIODIC'ELD IS PERFORMED EVEMY 36 MONTHS AS REQUIRED. 2-#C(At 026"11 490-66. <br /> 2.SECONDARY CONTAINMEN,r COMPONENTS ARL I L--S-1 L4,0 EVERY 36 MONTHS. <br /> 490-67. <br /> SPILL BUCKETS ARF'I'LS'I'L,'L)"ANNUALLY. <br /> VIII. RECORD KEEPING <br /> The following monitoring/inaintjonaricc records are kept for this facility: 490,161j. <br /> 0 a.AI,,ARM LOGS 0 b.VIS(JAI.INSPF.crION RUCORDS ❑ c TANK INTEGRITYTESTING RrSl.Jl.TS <br /> E] d,SIRTESTING kESULTS(and supporting docuriteritation records) Q C. I ANK UALICANG RESULTS(and supporting dmumullwicill 1mulLIal <br /> f.ATC,TESTING RESULTS(and supporting docuiruuIL-itioti records) C] g.CORROSION PROTECTION 60-DAY I.o."'S <br /> h.wUH-MENT MAINTENANCE AND C,'AI.IBRATION RECORDS <br /> IX- TRAINING <br /> 19 Personnel with LJS,r monitoring responsibilitio arc familiar with all of the following d0CtL1nCl1ts relevant to their job duties: 4W-691% <br /> REI-I PLENCE DOCUMENTS MAINTAINED AT FA('ILITY(Check all that apply) <br /> Ti IIS UNDFR.(jR0l JND ST-ORAGEIANK MON IT()RIN(i PLAN(Required) 4W.6-A. <br /> OPERATING MANIJAIA F()K L%LICTRONIC MONITOKINO EQUIPMfi-N-1(Ikkqi6j;r(1) 490.4-9a. <br /> F1 CALWORNIA UNDERGROUND S'J'ORA(YETANK REGULATIONS 4'tM;'4 <br /> El CALIFORNIA I)NDERGROUND 9FORArxFTANK LAW 41^69e. <br /> STATE WATER Rr-%OIJRCFS CONTROL BOARD (SWRCR) PUBLICATION: "TIANDDOOK FOR TANK OWNERS - MANUAL AND 490-69r. <br /> STATIS'FICAL INVVN'I()KY KLCUNC'lLJATJ(Jj11J-❑ awed* <br /> PUIR1,1CATION:-UNDERSTANDING AUTOMXVIC,rANK GA(JGlN(7aSYSTFMS- 4-Aw,* <br /> F1 OTHER(Specify): 4-A-6A <br /> This facility h&3 a"I)Wignatod UST Olwimtor`;whu[jut;pla.)d the CaHC5min(AT System Operator Exam Mminiqtert-di by the Irimmational Codc Council 490-70 <br /> (ICC). The "Desi6mated UST Operator-will train facility employees in thw proper operation and maintenance of the UST systems annually,and within 3U <br /> days of hire.This training will j(icJ%jdc,but is not limited to,the Following: <br /> operation of the UST systems in a lymniner consistent with the kcility's best lnisnap,ctrfent practices. <br /> rho facility villplovL=",ivic with jcgiwd to the monitoring cquipmunt ua ap"ificki isithis USTMonitaring Plan. <br /> > "rhe facility cinplovec'sroic with regard to spills and overfills as specified in the facility's,'I IST Responsol1lan. <br /> )0 Naine(s)otcolitut person(s)for emergencics told 11totlitojfilig alarms. <br /> X- COMMENTS/ADDITIONAL. INFORMATION <br /> Provide additional comments here or indicate how many paecs with additional information on specific inonitoring procedures are attached to this plan, 41M.71 <br /> XT- PERSONNET, RESPONSIBILITIES <br /> 'rho LI T(,1wriur/(*ciaLof is re"nsible for(:n%nring thul., I )the"Iy/tOutilIC Ulfl'111(>11itortor,jickiVitiL-,4 and TnainLunanuc vI`jLJSI'Jeak deuxtionequipmunt cavurud <br /> by this plan occum 2.)all coiglitions that indicate a possible �i!,ttignpring rvcv!�Is.4�q,maintajined pr <br /> .............. <br /> THE 1',OLLOWIPERSON( )A FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: <br /> YP <br /> NAMEX: A— , V, <br /> NAME: 4W-741 TITI.F, <br /> The DesignaW UST Operator shall perform it monthly visual inspection of the facility,p(ovicit.it report to the owner/opormot,W inform the owner/operator of Any <br /> conditions that need follow-up action. <br /> OWNER/OPERA RSIGNATURE <br /> CERTIFICATION:I certifyAt the i4ormatio5ttlovided herein is q4p4nd accurate to the best of my knowledge. <br /> 11 1,4,71. <br /> -W)NATURE UA*VF,: <br /> 7 lRek <br /> ftF,PRF.1,FxTf,x;-III i 'rank ownff/L. rMZF..ih1'0 ffialf 113 Authowtil RoRdImiative Of0wrWr 4'X0, <br /> PPL I <br /> - — -- ---- txtili E—, 41M-79, <br /> A PPL ICANT NA;:;;r.(17nt): APPLLCAN'r TITI..F: <br /> (IPC,F IJST-D(12/2007)-3/4 <br />