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01/31/2008 THU 15:44 PAX 2093433 SJC EHD 2004/010 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN — (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING (Check °ll rliar apply) UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) I CONTINUOUS ELECTRONIC MONITORING ❑ 2. FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONE 490-54a ❑ 4 NO DiSPE.NSFRS El 99.OTI_ICR pecify) vM-s4a ....9.0. 54 ..... -. `, ago -ss. LEAK MONITOR MANUFACTURER: Y EE Y<007— MODEL. #: TLS - 3S0 ago -56 LEAK SENSOR MANUFACTURER:yIC ED ER 9 Dar- 490-57 Moor:►.. #(s): o 7 4 S/ 3 *6 - ZO$ 490.59. DETEC'fioN OF A LEAK INTO THE UDC "['RIGGERS AUDIBLE AND VISUAL, ALARMS. ($ a. YES ❑ b. NO 4110-19 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. I$ a. YES ❑ b. NO 41A-60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. 19 a. YES ❑ b. NO 490-61 UDC MONITORING STOPS THE FLOW OF PRODUCT ATTHE DISPENSER. fW a. YES [Ib. NO 49062. _.. - - ... __. _ ........._. U 11 llC CONSTRUCTION IS: }� 1. StNGLG WAI,I,❑ 2. DOUBLE WALL ........... am+t3 IF DOUBLE WALL: 490.64a. r,;nri,:uc r IIIA I 'ZPACP K M()NnTnRFD BY n a. LIQI IID ❑ b. PRFSSLIRF. ❑ c. VACUUM Hli� 1 HE SI CONDARY CONTAINMENT OF THE LDDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a. Yf?S ❑ b. NO 4904"10 VII. PERIODIC SYSTEM TESTING ❑ I. FLD TESTING: '1'Ii1S FACILITY HAS BE,l N NOTIFIED BY 7•I IE STATE WATFR RESOURCES CONTROL BOARD THAT rNHANCED amties. I i AK DF.1EC ICON, L!,.Dj MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. J23 MR §2644.11 ®2 SECONDARY CONTAINMENTCOMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66. ® 3. SPILL BUCKETS ARETESI'ED ANNUALLY. 49a•67 VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 090.6x. ® a. ALARM LOGS ❑ b. VISUAL INSPECTION RECORDS ❑ c. TANK INTEGRITY TESTING RFSUi.:['S ❑ d .sw : i .TING ItESIJLTS (and supporting (iocumentation records) ❑ c. TANK GAUGING RESULTS (and supporting documentation records) ❑ L A 10 i 1 LS FING RESULTS (and supporting documentation records) ❑ g. CORROSION PROTECI'ION 60 -DAY LOGS 0 h. EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING Personnel with LIST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: Oso -(h. REFF.RFNCti DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) 0 JI HS UNDERGROIJND S'T'ORAGE "LANK MONITORING PLAN (Required) 490.690. 00111 RA71NG MANUALS FOR ELECTRONIC MONITORING EQUIPMFN'1' (Required) 490.690 ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49MIX ❑ CALIFORNIA UNDERGROUND S'T'ORAGE TANK LAW 490.69e. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL. AND 490-69L STATISTICAL INVENTORY RECONCILIATION" El SWRCB PUBLICATION; " IJNDF..RSTANDiNG AUTOMATIC TANK GAUGING SYSTEMS" 49o•69g [j uilILlt (Spcciiyl. 4m+-r,N 49040h icilm i " Designated I3ST Operator" .vho has passed the California UST System Operator Exam administered by the International Code Council 490-70, Uo I Upeiatoi' will t7am facility employees in file proper operation and maintenance of the US'I" systems annually, and within 30 days of hirr I Ills training will include, but is not limited to, the following: Y Opcmoon of the UST systems in a manner consistent with the facility's best management practices. Y The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan. r The lacility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. Y Namc(s) of contact person(s) for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments he or indicate how many pages with additional information on specific monitoring procedures are attached tths Ian. �o 490.71 IpYEtCF4owtZtvEN1?oA✓ - /Y1rfCR/An/ecAL F4A?AtrtS SEr Ar 905' XI. PERSONNEL RESPONSIBILITIES 'Ire UST Owner/Operator is responsible for ensuring that: I) the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered by this plan occurs 2.) alt condluons that indicate, a possible release are invesugaled; and 3) all monitoring records are maintained properly. TI II: FOLLOWING PE,RSON(S) ARE RESPONSIBLE FOR PERFORMING THE MONI'T'ORING AND EQUIPMENT MAINTENANCE: NAME: 3'us11Al G 0040CIA44 490-72. TITLE: 4t4ry I,cc04 490-73. NAME: 4SX04. TI'I'Ij.': 4911.75. The Designated UST 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 rollow-up action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION: I certify that the information provided herein is true and accurate to the best of my knowledge. API'L.n .N01 SIGNAtt;Rh DATE: 49077. RTPRESI N I M; 5,K Tm* 0%vncrJ0 cralor ❑ ? faulil+ Orvncr/0 eralor I] s. Aulhori[cd R ttCSCItlmivc of Oalivr 490-76. APPt.iCAN"I' NOMI: (print): amt-7R. APPLICANTTITLE: 490.79. m . 2.-11:,j ago L / Cu rCA.1A V -r UPCF UST -D (12/2007) - 314 www.unidocs.org