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UNIFIED PROGRAM CONSOLIDATED FOROM <br /> ` UNDERGROUND STORAGE TANK <br /> MONITORING PLAN (Page 2 of 2) <br /> VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING <br /> 1. C MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54a <br /> 6V490.54b <br /> 1.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE <br /> ❑4.NO DISPENSERS ❑99.OTHER(S i ): <br /> PANEL MANUFACTURER: 00 T 9 490-55 MODEL#: rtLS 350 490-56. <br /> LEAK SENSOR MANUFACTURER: V a:7)E P- P-01D j 49°"57 MODEL#(S): Lt%q 2_0 B 490-58 <br /> DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS Va.YES ❑b.NO 49059 <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN Wa.YES ❑b.NO 490-60. <br /> FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. [�.YES ❑b.NO 49061 <br /> UDC MONITORING STOPS T FLOW OF PRODUCT AT THE DISPENSER Ltf a.YES ❑b.NO 490.62 <br /> 2.UDC CONSTRUCTION IS ffl.SINGLE-WALLED ❑2.DOUBLE-WALLED 490.63 <br /> IF DOUBLE WALLED: 490-64a <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: 0 1.LIQUID Q 2.PRESSURE 0 3.VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS a.YES ❑b.NO 490.64' <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 EL MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.i <br /> 9'2.,SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 <br /> 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490.67 <br /> VIII.RECORDKEEPING <br /> T'he,t'ollowing monitoring/maintenance records are kept for this facility: <br /> Lff Alarm logs 490.68a ❑Visual Inspection Records 490.68b ❑Tank integrity testing results 490-68c <br /> ❑SIR testing results(and supporting documentation records). 490.68d ❑ Tank gauging results(and supporting documentation records). 490-68e <br /> ❑ATG Testing results(and supporting documentation records).4go-68f ❑ Corrosion Protection 60-day logs 4go-68g <br /> [Equipment maintenance and calibration records. 49068h <br /> IX.TRAINING <br /> E31P.-onnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 49"9a <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) <br /> THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)4gob9b <br /> OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)4go-69c <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49"94 <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49069. <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"490-698 <br /> OTHER(Specify):M69k M6% <br /> ly This facility has a"Designated UST Operator"who has passed the California 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 /> ➢ 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. COAEVIENTS/ADDITIONAL INFORMATION <br /> Provide additional comments here or indicate how many pa es with additional information on specific monitoring procedures are attached to this plan.49o-71 <br /> T F, OP 0Vr-tt F; 1T"OBE W17H MECtIAPIIc L FLAPPER <br /> SF_T AT q5% <br /> M.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 490.72 TITLE 490.73 <br /> NAME 49o-74 TITLE 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.OWNER/OPERATOR SIGNATURE <br /> CERTIFICATION:I fy 1hat the information provided herein is true and accurate to the best of my knowledge. <br /> APPLICANT SIGNATURE 490-76 DATE: 490-77 <br /> L <br /> REPRESENCTING, 1 Fgdlily Owner/Operator 0 3.A 'z R r 'v fOwner <br /> APPLICANT NAME(print): 490-78 APPLIC ITLE: 490-79 <br /> UPCF UST-D(1212W7)3/4 <br />