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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) z _ ,. � i I. UDC MONITORING 15 PERF6 D USING THE FOLLOWING METHOD ., . � �; 490-546 ✓ ❑ 1 CONTINUOUS ELECTRONIC MONITORING ®2.FLOAT AND CHAIN ASSEMBLY 0 3.ELECTRONIC STAND-ALONE 490.54b ❑4:NO DISPENSERS ❑99-OTHER(Specify)'-- -- -- ---—-----— -- -- — — — - - 490 ss — PANEL MANUFACTURER:Bravo MODEL# 490-56" — -------- LEAKSENSOR MANUFACTURER: 494-s t + MODEL#(#(S) --—----- — -- — 490.58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a:YES N b NO 446:3T- UDC 90 59UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN490-CO.❑ a.YES ®b.NO 490-b FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES [b.NO ¢Q0'bi UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ® a.YES ❑b.NO 490-62 2.UDC CONSTRUCTION 19 Gal-SINGLE-WALLED 02.DOUBLE-WALLED 49063 IF DOUBLE,WALLEDaoOTa� UDC INTERSTITIAL SPACE IS MONITORED BY: 1.LIQE1Id_ 2:PRESSURE 3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES O b.NO 4w"5 !. E1 D TESTING:THIS FACiLI: HAS BEEN NOTIItIEft BY Ti1E STATE.WATER RESOURCES CONTROL BOARD THAT RHH4KED 494 65 MUST BE NERFORMED.`PERIODIC ELI?IS PI:RPt?RMRi}EVERY 36 MONTHS AS Rl(%IREDCCR_ 644�__—_ �(2.iECONPAax TAIN NT'COMP()k FLATS ARE TES PED EVERY 36 MONrHs. 490-66 ---- - -- - ----------------- -3 ---- SPlLI gIUCKETS ARE Ii ANNUAELY4.67 TIS following monitorinprfmaintenance records are kept for this facility_ Alarm logs 490 vs. { trtsnal fnsppction Records 490-686 ❑Tank integrity testing results 4vo-sac ❑SI[t testing results(and sup` documentation records). 490-Od ❑ Tank gauging results(and supporting documentation records). 490.68e ❑ATG Testing regalis(and supporting documentation records).490.68r ❑ Corrosion Protection 60-day logs a90.6sa ` Equipment maintenance arid calibration records. 49"ah ❑Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-698 REFERENCE DOCUME14TS,MAINTAINED AT FAIGILITX(Check all that apply) THIS , ERGROUk S"rOl RAAGE, TANK MONITORING PLAN(Required)49o.69b >OPERATING It4ANUALS POR ELECTRONIC MONITORING EQUIPMENT(Required)490.w y CALIFORNIA UNDERGRO01411STORAGE TANK REGULATIONS 49o.49d ❑ CALIFORNIA UNDWROEIN6 STORAGE TANK LAW 490.69. ❑ STATE WATER RESOURCES;CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY,RECONCILIATION"490-W ❑ SWRCS PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"49a.49s ❑ OTHER(Specify):ice;miioj 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 isnot limited to,the following: ➢ Operation of the UST systems in a manner consistent with the facility's best management practices The facility employee's rote withtogard to the monitoring equipment as specifiedin UST Monitoring Plan A The facility employee's role with regard to spills and ovaifiils as specified in the UST Response Pian Nantes of contact persons)for JOuctgcncics and rannitorml;alarms.490-7o Provide additional comments hotel or i ,to how many,pages with odditionalinformation on speci to ikormg•pracedu�rpes�are attached-to this plan,a9a7t > OeatoiiloreVarmOn d g##�With n4ch ai'ft r S4@ a1l$ fe. A le-G6 �t Act aP;-sF+C aowle Wit -f Fva The UST Owner/Opemicir 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 property. The faillowi personal are responsible for performing the monitoring and equipment maintenance: NAME 49o-7z TITLEk r 490-73 NAME 49o.74 TITLE } 490-75 I The Desfgioatedd 1001M ttr.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. CEII.TIFICATION:I certify haf the inLot ion providedhemin is true and accwat to the best of my knowledge. APPLICANT SIGNATU 490.76 DATE: 490-77 311112009 i ICANTNAME(print}: '73 APPLICANT TITLE: 490-79 Mike Ef a . Cardlock Manager UPCF UST-0(12/2007)3/4