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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING P (Page 2 of 2) 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 4W54a ❑ 1.CONTINUOUS ELECTRONIC MONITORING 012.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC ST ALONE 490-54b ❑4.NO SPENSERS 99.OTHERS i ): —"— ------------------ -------- ------------------- PANEL ACTURER: 4 Bravo 1o! MODEL#: 490-56. LEAK SEN R MANUFACTURER: 49&57 I MODEL —�——�--- 490-58 DETECTIOINNF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES ®b.NO 490.59 UDC LEAK AL RM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES ®b.NO 490.60. FAILURE/DISC ECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP S OWN. ❑ a YES ®b.NO air UDC MONITORIN OPS THE FLOW OF PRODUCT AT THE DISPENSER ® a.YES ❑b.NO 490-62 2.UDC CONSTRUCTION ❑2.DOUBLE-WALLED a9.63 ®I.SINGLE-WALLED o IF DOUBLE WALLED: 490-644 UDC INTERSTITIAL SPA IS MONITORED BY: Qj.LIQUID _2,PRESSURE 3 ACUUM A LEAK WITHIN THE SEC ARY CONTAINMENT OF THE UDC TRIGGERS AUDIBYE AND VISUAL ALARMS � — ❑a YES ❑b.NO a�.6ah 1. ELD TESTING: THIS FACIL FIAS'BEEN NOtI3 BY THE STATE Wk RESOURCES CONTROL BOARD THAT ENHANCED 490.65. MUST PERFORMED: PERIODIC ELD IS PERF0 EVERY 36 MONTES AS REQUIRED. 23 CCR 2644.1 2.SECONDARY CONTAINMENT CQ PONEN r3 ARE b EVERY 36 NTHS. 4' 3.SFILL BUCKETS ARE TESTED ANN LY. — 49067 The following monitoring/maimenance records are ke or this facility: ®Alarm logs 490baa Q Visual Inspection Records b ❑T integrity testing results 4%-ac ❑SIR testing results(and supporting documentation reco ). 490 fi8d ❑ T ng results(and supporting documentation records). 490.6se ❑ATG Testing results(and supporting documentation reco ).490.63f ❑ rrosion Protection 60-day logs 49Q-6aa ®Equipment maintenance and calibration records. 49o4sh ❑Personnel with UST monitoring responsibOiBees are farniliac wim of the following is relevant to their job duties. 49m9a REFERENCE DOCUMENTS TAINED AT FACIL heck all that apply) THIS UNDERGROUND STORAGE TANK MON£fO P (Required)49"9b ® OPERATING MANUALS FOR ELECTRONIC MONI RING UIPMENT(Required)490 69c ❑ CALIFORNIA UNDERGROUND STORAGE TANK GULATI Sago 69d ❑ CALIFORNIA UNDERGROUND STORAGE TAN AW 490 696 ❑ STATE WATER RESOURCES CONTROL BO (S CB) P LIGATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY REGONCILIA N'4 ❑ SWRCB PUBLICATION:"UNDERSTANDIN AUTOMATIC TANK G GING SYSTEMS"490 69g ❑ OTHER(Specify):M69h,M6m IN This facility has a"Designated UST Operator" has passed the California US ystetn Operator Exam Ministered by the International Code Council(ICC). The"Designated UST Operator"will train facility mployees in the proper operationNh ance of the UST kms annually,and within 30 days of hire.This training will include,but is not limited m,the foil ing: ➢ Operation of the UST systems b a consistent with the facility's best mactices D The facility employee's role with re the monitoring equipment as specifieT Monitoring Plan ➢ The facility employee's role with rep to spills and overfills as specified m thense Plan ➢ Names of contact person(s)for eme encies and monitoring alarms.49o.7o Provide additional cowmen is here or' irate how many with additional information on speci t monitoring p are attached to this plan.49P.73 Overfill Prevention=dr tube with mechanical flapper set at 95%. '� c` W�c x"�,.:`�"'`� ;�`' .. •-�: "� s x F' ,�� spa€ The UST Owner/Operator is r possible for ensuring that:l)the daily/routine UST monitoring activities and intenance of UST leak detection equipment covered by this plan occurs,2)all comb ons that indicate a possible release are investigated,and 3)all monitoring records a maintained properly. The following persons) responsible for performing the monitoring and equipment maintenance: NAME Mike Elias 49oa2 TITLE Q@Alock490-73 NAME JaMeS tt 490-74 TITLE Slee Technician 49-75 The Designated Operplor shall perform a monthly visual inspection of the facility,provide a report to the owner/ rator,and'inform the owner/operator of any conditions that need lbw-up action. CERTIFICA ON.I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT GN A 490.76 DATE: 490-77 3111/2009 APPLIC NAME(print): 490'78 APPLICANT TITLE: 490-79 Ellason Cardlock Manager UPCF UST-111(t2 07)3/4 \�