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NIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK • MONITORING PLAN (Page 2 of 2) VI.UNDER`DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-544 490-546 ❑ 1.CONTINUOUS ELECTRONIC MONITORING [12.FLOAT AND CHAIN ASSEMBLY 3.ELECTRONIC STAND-ALONE ❑4_NO DISPENSERS --E399_OTHER(Specify)_—–—– _----- ___—_ EL PANEL MANUFACTURER: 1� aWi5 MOD #: –'–' 490•56. LEAK SENSOR MANUFACTURER: e (`� �®! 490-s7 i MODEL#(S): Q� 490.58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES ffb.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN [> a.YES ❑b.NO 490-60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑b.NO 490-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. a.YES ❑b.NO 490-62 2.UDC CONSTRUCTION IS Url.SINGLE-WALLED ❑2.DOUBLE-WALLED 490-63 IF DOUBLE WALLED: –avo-6ae UDC INTERSTITIAL SPACE IS_MONITORED BY: ❑L LIQUID-_-2_PRES91E Q 3 VACUUM______–_________________________-___-__-______---------------- A LEAK WITHIN THE SECONDARY CONTAINMENT OF T14E UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490-64b VII.PERIODIC SYSTEM TESTING ❑ I. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. _ LEAK DETECTION(ELD)MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED_(23 CCR§2644 .1) _ — SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS, 490-66 SPILL BUCKETS ARE TESTED ANNUALLY. 490-67 VIII.RECORDKEEPING `?Th following monitoring/maintenance records are kept for this facility: Alarm logs 490-68a ❑Visual Inspection Records 490-68b ❑Tank integrity testing results 490-68c ❑SIR testing results(and supporting documentation records). 490-68d ❑ Tank gauging results(and supporting documentation records). 4go-68e ❑ATG Testing results(and supporting documentation records).490-68f ❑ Corrosion Protection 60-day logs 490-68g RKEquipment maintenance and calibration records. 490-68h IX.TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-69a REE,RENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490.696 OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490.690 ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490.69f ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-69g OTHER(Specify):M69h,M69i 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 is not limited to,the following: ➢ Operation of the UST systems in a manner consistent with the facility's best management practices ➢ The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan ➢ The facility employee's role with regard to spills and overfills as specified in the UST Response Plan ➢ Names of contact person(s)for emergencies and monitoring alarms.490-70 X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.490-71 ,c>A r o �,j .A� v) 1 eL ecwC fly q4o XI.PERSON EL RESPONSIBILITIES 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 this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The following person(s)are responsible for performing the monitoring and equipment maintenance: NAME S I. 490-72 TITLE a A f1- � G C 490-73 NAME ti eti y gq Q 490-74 TITLE 490-75 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 conditions that need follow-up action. XII.OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that a fnfornt tion provided herein is true and accurate to the best of my knowledge. APPLICANT SI TURF 490.76 DATE: 490-77 REPRESENTIN • 1.Tank wn r/ for 2.F ili Owner/O rator 3.Authoriz d Re resentative of weer 490-78 490-79 APPLICANT NAME(print): APPLICA T TITLE: A_ UPCF UST-D(12/2007)3/4